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(c) 2010-2026 Jon L Gelman, All Rights Reserved.

Wednesday, September 24, 2014

NJ 2015 Workers' Compensation Rates

For calendar year 2015, the maximum unemployment insurance, temporary disability insurance and workers' compensation benefit rates, the alternative earnings and base week amounts, and the taxable wage base are listed below.

Football and brain trauma: a workplace health issue

Today's post is shared from http://scienceblogs.com/thepumphandle
The news that almost one third of NFL football players can expect to suffer the effects of brain trauma made headlines in major media. While it is not surprising that large men, often leading with their heads, bashing each other week after week suffer some consequences, what was unexpected was how many players are likely to be injured, and that the NFL actually acknowledged this reality.
Obviously, the findings lead to the question of what to do about it besides compensate the injured. In the context of workplace injuries the injury rate in this industry is tremendously high and the severity of the resulting health conditions, including life altering and shortening conditions such as Alzheimer’s disease, chronic traumatic encephalopathy, and Parkinson’s disease should raise serious alarm bells and initiate efforts to reduce the injury rate.
A major question is whether players can really be protected from head trauma given the way the game is played and the personal protective equipment that is available. The League put administrative controls in place a year or two ago, trying to limit certain types of contact to avoid butting heads, but injuries continue to occur. Helmets, the primary protective gear are technologically limited and cannot be designed to really protect the brain from serious trauma. Professional football is an example of work that cannot be made safe, at least without fundamentally altering the way the game is played.
As...
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Pharmaceuticals in the News

This post is authored by Judge David Langham and shared from http://flojcc.blogspot.com/
Alzheimer’s brings me to medication and litigation this morning. At first blush, the connection of Alzheimer's to workers’ compensation seems tenuous, but the connection comes back to pharmaceuticals, and everyone knows that from muscle relaxants, to pain inhibitors, to blood pressure control and more, pharmaceuticals play a role in many workers’ compensation cases.
Pharmaceutical companies invest huge amounts of money in the research and development aspects of medications. After they perfect something, they spend a great deal of time and money in the approval process required by the Food and Drug Administration (FDA). In most cases, medication must be approved by a vetting panel at the FDA, without which approval is unlikely. This is not always the case, however, and sometimes the FDA even overrides its own panels to approve seemingly unnecessary medications which present potential risks to patients and society.
The reward for all that effort, time and money is a patented medication for the marketplace. The patent generally lasts for 20 years. Thus, for 20 years the company can charge “name brand” prices for the medication it has developed and generate profits that are commensurate with all of that investment, rather than merely with the cost of manufacture and distribution. Sometimes the actual chemicals involved in a medication are not very expensive and the manufacture/distribution process not complex.
The fact...
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Insurers Hesitant To Cover Many Proton Beam Therapy Treatments

Today's post was shared by Kaiser Health News and comes from www.kaiserhealthnews.org

Everyone seems to agree that proton beam therapy--a type of radiation that can attack cancerous tumors while generally sparing the surrounding tissue--is an exciting technology with a lot of potential. But some insurers and disease experts say that, until there’s better evidence that proton therapy is more effective at treating various cancers than traditional types of less expensive radiation, coverage shouldn’t be routine.


That approach doesn’t sit well with proponents, some of whom say that insurance coverage is critical for necessary research of the controversial therapy’s uses.
Meanwhile, the number of proton therapy centers -- huge structures that can cost more than $200 million -- continues to increase. Fourteen are in operation in the United States and a dozen more under development, according to Leonard Arzt, executive director of the National Association for Proton Therapy.
Critics assert that the rush to build the centers is putting a very large cart before the horse.
In general, “the evidence has failed to demonstrate that there is a significant improvement in outcomes with proton beams,” says J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society. “It’s fair to question whether the number of facilities that are being constructed really reflect the proven value of proton beam therapy.”
A 2012 study published in the...
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Cal/OSHA fines UC Berkeley $26,000 in death of custodian

Today's post was shared by CAAA and comes from www.sfgate.com


State workplace safety officials have fined UC Berkeley more than $26,000 for violations in connection with the death of a custodian who tumbled 22 feet from a lift that collapsed as he was cleaning windows in April.
California's Division of Occupational Safety and Health determined that supervisors of the custodian, Damon Frick, 45, of Richmond failed to ensure that the lift was assembled correctly and allowed Frick to use it unsupervised.
UC Berkeley said that as he assembled the lift, Frick apparently ignored a label warning of "serious injury or death" if a certain piece was inserted as Frick did it.
At the same time, "we have documentation that Mr. Frick was fully trained in use of this lift," the university said.
But the training was ineffective because it was provided more than two years earlier, Cal/OSHA inspectors said.
"This unit is used approximately once a year with no in-between training or practice," according to the citation issued Sept. 9. "The training was ineffective as the last training was provided on March 12, 2012.
On April 7, Frick was vacuuming auditorium window sills at International House at 2299 Piedmont Ave. while standing on an elevated platform made by Upright Lifts Inc.
At 7:45 a.m., another employee heard a crash, rushed to the auditorium, and found Frick "flat on his back on the floor along with the lift that tipped over," inspectors said.
There were no witnesses. Frick was taken by ambulance...
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G.M. Recalls Impalas and Cadillacs Over Risk of Brake Fires

Today's post was shared by Take Justice Back and comes from www.nytimes.com



WASHINGTON — General Motors is recalling more than 221,000 vehicles because of a parking-brake defect that can cause brake pads to stay partly engaged, which can lead to “excessive brake heat that may result in a fire,” according to documents posted Saturday on the National Highway Traffic Safety Administration’s website.
The recall covers 205,309 vehicles in the United States and 16,249 elsewhere, said Alan Adler, a G.M. spokesman. It includes 2014-15 Chevrolet Impalas and 2013-15 model Cadillac XTS cars.
G.M. said it was not aware of any crashes, injuries or deaths from the defect.
N.H.T.S.A. said the fire risk stemmed from the rear brakes generating “significant heat, smoke and sparks.” The agency also warned that drivers of affected vehicles might experience “poor vehicle acceleration, undesired deceleration, excessive brake heat and premature wear to some brake components.”
The Impala has been at the center of numerous recalls and investigations this year, as G.M.’s string of recalls worldwide approaches 30 million vehicles.
In February, the 2014 Impala was recalled for a transmission defect that could allow a parked car to roll away. In June, certain Impalas were recalled for ignition problems, and others for a joint fastener that was not torqued to specification.
Then in July, G.M. recalled more Impalas over a possible loss of power steering, and later that month N.H.T.S.A. opened an investigation into the potential...
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How Insurers Are Charging You More for Your Generic Drugs

Today's post is shared from propublica.org

The Affordable Care Act bans insurance companies from discriminating against patients with pre-existing conditions. But some policy experts say insurers could be doing just that by forcing people with chronic illnesses to pay more for their drugs.

ProPublica's Charles Ornstein explains that insurers have long used a tiered pricing system to steer consumers away from expensive brand name medications. But according to a recent editorial in the American Journal of Managed Care, several prominent health plans are taking this tactic one step further and charging higher co-payments for some generic drugs.

The editorial's authors examined six health plans to see how much they were charging for generic drugs to treat 10 conditions. For certain conditions like epilepsy and HIV, some plans didn't offer any generic drugs in the preferred category -- leaving patients to pay more or find a new plan.

"There are a number of advocates that contend that insurance companies are, while not explicitly charging people more to sign-up or charging them higher premiums, that they're using the way they structure their drug benefits to in fact charge people with pre-existing conditions more," Ornstein says.

The companies say they aren't targeting patients with pre-existing conditions.

So what can you do to make sure you're getting the best price for your prescriptions?

Click here to read the entire article.

Climate Change: A Factor Escalating Compensable Conditions

Global climate change is anticipated to cause an increase in adverse medical conditions and will ultimately impact work-related medical conditions and diseases. A recent report in the Journal of the American Medical Association (JAMA) discuses the anticipated escalation.

"Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health professionals have an important role in understanding and communicating potential health concerns related to climate change, as well as the cobenefits from burning less fossil fuels."

"By 2050, many US cities may experience more frequent extreme heat days. For example, New York and Milwaukee may have 3 times their current average number of days hotter than 32°C (90°F). The adverse health aspects related to climate change may include heat-related disorders, such as heat stress and economic consequences of reduced work capacity; and respiratory disorders, including those exacerbated by fine particulate pollutants, such as asthma and allergic disorders; infectious diseases, including vectorborne diseases and water-borne diseases, such as childhood gastrointestinal diseases; food insecurity, including reduced crop yields and an increase in plant diseases; and mental health disorders, such as posttraumatic stress disorder and depression, that are associated with natural disasters. Substantial health and economic cobenefits could be associated with reductions in fossil fuel combustion. For example, the cost of greenhouse gas emission policies may yield net economic benefit, with health benefits from air quality improvements potentially offsetting the cost of US carbon policies.

Climate Change Challenges and Opportunities for Global Health, AMA. Published online September 22, 2014. doi:10.1001/jama.2014.13186

Click here to read the entire article.

….

Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thompson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thompson-Reuters). For over 4 decades the Law Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  have been representing injured workers and their families who have suffered occupational accidents and illnesses.

Tuesday, September 23, 2014

Controlling prescription cost: Focus on Pennsylvania

Today's post is shared from pilly.com

Violence in the Workplace: UPS Employee Kills 3 Aftert Getting Fired

Today's post is shared from the nydailynews.com/


Recently fired UPS worker Joe Tesney, identified by local news sites, allegedly opened fire in a UPS warehouse where he killed two people before himself.

Three people are dead after a recently-fired UPS employee, wearing his uniform, opened fire inside an Alabama warehouse Tuesday morning.

The gunman, identified by local news stations as 45-year-old Joe Tesney, is among the dead at the Birmingham shipping center after taking his own life at the scene, police said.

The gunfire at Inglenook Lane was reported to police around 9:21 a.m. as an active shooter, Chief A.C. Roper said.

Lt. Sean Edwards said the two men killed by the gunman appeared to be higher-ranked UPS employees.

"It appears that the shooter knew exactly who he wanted to target at the time," Edwards told WBRC.Tesney, pictured, is listed as a UPS driver on his LinkedIn page. Police said the suspected gunman was fired on Monday before returning to the warehouse while armed.

The 45-year-old married father of two girls had been fired Monday from the company, The Birmingham News reported.

This news followed a previous attempt by the company to terminate him within the past month. The disgruntled man appealed the decision, but lost in recent days.

Why he was fired was not immediately known.Gunfire was reported around 9:20 a.m. Tuesday at the Birmingham, Ala. facility. Three people are dead.

All of the dead, described as white adult men, were found in the warehouse area near the building’s...

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The Ultimate Wrongdoer: The Arab Bank

Yesterday a persevering plaintiff's legal team, in a landmark case, was able to obtain a verdict against an international bank that handled funds used by terrorists. It has been a decade long legal battle to seek justice against an ultimate wrongdoer.

The determination of the the same lawyers who mounted successful cases against: the asbestos industry, big tobacco and lead paint companies, once again achieved victory in the civil justice system.

While workers' compensation is a primary and limited payment of benefits, the real force for potential change in behavior is the responsibility imposed through litigation in the civil justice system against the ultimate wrongdoer. The lawyers who fought the arduous task against the Arab banks have accomplished a monumental victory that will all benefit mankind.

"The eleven member jury agreed with plaintiffs’ claims that Arab Bank knowingly and systematically provided financial support to the leadership of Hamas and to the families of terrorist operatives including suicide bombers. Motley Rice LLC represents nearly 20 U.S. citizens injured in suicide bombings and other terrorist attacks carried out by Hamas in Israel and the Palestinian Territories, in addition to dozens of other American victims of terrorism carried out by other groups, such as the Palestinian Islamic Jihad, and thousands of foreign plaintiffs under the Alien Tort Statute also pursuing claims against Arab Bank.

“We are so pleased that these plaintiffs have achieved justice after this brutal ten-year battle. Today’s verdict is a testament to their fortitude and determination,” said Motley Rice anti-terrorism and human rights attorney Michael Elsner, who represents plaintiffs in the case. “The late Motley Rice co-founder Ron Motley filed this action back in 2004. His passion for justice and his trust in jury trials was realized today. We all have a role to play in preventing terrorism in whatever sector we operate. It is now clearer than ever that this obligation extends to banks.” 
“I strongly believe that this jury’s verdict marks a critical point in history and hopefully a turning point in the war against terrorism, especially now that we are faced with the rise of more terrorists,” stated Motley Rice client Joshua Faudem, who was injured in the Mike’s Place suicide attack bombing in Tel Aviv, Israel, on April 30, 2003. “By cutting off the financial support for terrorism, we are able to hurt terrorists the most. Without funding, they are not able to have the means to purchase equipment, bombs or arms, gain access to carry out violent acts or to create an elaborate system of support. I am proud to be part of this historic case.”
“This is a historic day for the banking industry. This jury’s verdict should be a wake-up call to all financial institutions that they cannot hide behind software systems and internal policies as an excuse to knowingly permit the financing of terrorism,” Elsner added. “Money is the fuel for terror and our only hope in preventing terrorism is shutting off the financial pipeline. Today’s verdict is a victory against terrorists and their networks of support.”

The following post is shared from the nytimes.com

A federal jury on Monday found Arab Bank liable for knowingly supporting terrorism efforts connected to two dozen attacks in the Middle East, the first time a bank has ever been held liable in a civil suit under a broad antiterrorism statute.

Arab Bank, a major Middle Eastern bank with $46 billion in assets, was accused of knowingly supporting specific terrorist acts in and around Israel during the second Palestinian uprising of the early 2000s.

The verdict is expected to have a strong impact on similar legal efforts to hold financial institutions responsible for wrongdoing by their clients, even if the institutions followed banking rules, and could be seen as a deterrent for banks that conduct business in violent areas.

The plaintiffs in this case, about 300 victims of 24 terrorist attacks, said the acts had been carried out by Hamas, and accused Arab Bank of supporting the organization by handling transfers and payments for Hamas members.

“Terrorist organizations are dependent on the financial system to operate,” Gary Osen, a plaintiffs’ lawyer, said after the verdict. “They’ve been able to thrive largely because folks like Arab Bank and others have turned a blind eye.”

Damages will be decided in a separate trial, which has not yet been scheduled. The plaintiffs have not asked for a specific amount.

The burden of proof in the trial, held at Federal District Court in Brooklyn, was high: The plaintiffs had to prove that the terrorist attacks...


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Upcoming Enhancement to the Workers’ Compensation Medicare Set Aside Portal (WCMSAP)

Today's post is shared from cms.gov

As of October 6, 2014, portal users will be able to enter
information on the new Prescription Drugs page for any
new and Work In Progress case before it is submitted
through the WCMSAP.
• Entry of the prescription drug information will be required,
when applicable, prior to submission of a case using the
portal.
• As is the current procedure, prescription drugs will be
verified and priced using the monthly Redbook Drug
Reference that is in effect at the date of submission.
• The new and revised WCMSAP pages that support entry of
prescription drug information are as follows:

  1. The Prescription Drugs page displays after a user clicks [Next] on the Diagnosis Codes page. 
  2. • This page requires users to indicate if a claimant is currently taking or is expected to take prescription drugs as a result of the workers’ compensation injury. 
  3. • If prescription drugs are anticipated, the user will click the [Drug Lookup] button to locate and select the applicable drug(s). 

Why so many people die in hospitals instead of at home

Today's post is shared from pbs.org
It was September 2012 and it was life-long smoker Paula Faber’s third cancer in a decade, but she did not hesitate.
“She was going to fight it every inch of the way,” says her husband Ron Faber.
By August 2013 after much fighting, Paula Faber died at age 72. Ron Faber now regrets the intervening 11 months of chemotherapy, radiation, painkillers and side effects that reduced his wife to 67 pounds of frayed nerves. Instead, the pain could have been managed so she could focus on the quality of life.
“I would have rather have had a really okay four-and-a half months than this endless set of treatments,” the stage actor said.
As they confronted Paula’s terminal diagnosis, the decision the Fabers made is among the most difficult anyone can make. But it turns out that in the New York metropolitan region, patients opt for aggressive treatment much more often than other Americans.
“New York City continues to lag in serious ways with regards to providing patients with the environment that they want at the end of life,” says Dr. David Goodman, who studies end-of-life care at Dartmouth College’s Geisel School of Medicine.
The reasons they do this are many, but most experts agree that it has less to do with the unique characteristics and desires of people in New York and New Jersey than the health care system and culture that has evolved here.
The result: More people dying in the hospital, often in...
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Ohio firefighters with cancer don't get workers' compensation and other benefits



Todsay's post has been shared from wkyc.com
Columbus firefighter Mark Rine was diagnosed with stage 4 melanoma in 2012. He can no longer work as a firefighter, but is working to educate his fellow firefighters and push for cancer presumption laws in Ohio.
Ask any firefighter and they can name at least one. That is one fellow firefighter who is battling cancer, or succumbed to it.
Last year, just in the Columbus Fire Department, 53 firefighters were diagnosed with cancer. Mark Rine used to work with some of them, and he wasn't surprised. Two and a half years ago Mark went to the doctor to have a suspicious mole checked out. It wasn't cancer. But the doctor found another that was. The test results were stunning. At just 30 years of age, Mark was diagnosed with stage 4 melanoma " I was shocked. I was shocked because I did feel great. I thought I was in great shape and had no issues," Mark told us when we visited him at his home outside Columbus.
He began treatment early in the summer of 2012 and was able to return to work for a time. Unfortunately, Mark's cancer has spread and he now has a tumor at the base of his spine. He now spends his days at home with his five children. "It's not worth it. I love my job. I thoroughly love it and miss it, but it's not worth all this," Mark says. He does his best to explain what it is like for firefighters after a fire. "As soon as you come out of a scene, most firefighters will understand what I am saying, you are sneezing black stuff for...
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Yop 10: States Average Total Claims Cost

Today's post is shared from http://daviddepaolo.blogspot.com/

Monday, September 22, 2014

NJ insurance adjuster admits to role in defrauding Turnpike Authority

Today's post is shared from northjersey.com/

A insurance adjustor with a Little Falls firm on Monday pleaded guilty to his role in a two-year scheme to defraud the New Jersey Turnpike Authority and several insurance companies of $900,000, U.S. Attorney Paul J. Fishman announced.

Robert Napolitano, 54, of Clifton, the owner of Dawn to Dusk LLC, an insurance adjusting company in Little Falls, admitted to one count of mail fraud. His sentencing has been scheduled for Jan. 8 in federal court in Newark.

Napolitano was accused of conspiring with a former turnpike authority employee to withhold money from claims for property damage caused by motorists.

In October 2011, he entered into a secret agreement with Gerardo A. Blasi, then a claims manager at the turnpike authority, to investigate accidents on the toll road and determine the cost of repairs to agency property, authorities said.

Napolitano would then submit the repair cost to the motorist’s insurance company on behalf of the turnpike authority, but without its permission, and request that the payment be made to his company. The complaint alleges that three insurance checks listing the turnpike authority as the claimant were mailed to Dawn to Dusk between October 2011 and January 2012, but Napolitano’s company never sent the money, totaling $230,000, to the turnpike authority.

The scheme worked by taking advantage of a change in the authority’s policy after the agency decided it would no longer attempt to recover...

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70% of Medicare Drug Plan Users Just Don't Switch Even Though Some Would Get A Better Deal

People are indeed creatures of habit, even if it costs them money. Kaiser Family Foundation reports today:

"Part D enrollment is highly concentrated, with five firms—UnitedHealth, Humana, CVS Caremark, Express Scripts, and Aetna—accounting for 63% of enrollees in 2014.3 While beneficiaries have the option to choose among dozens of plans each year, and often could save money if they switch plans, most (7 out of 10) beneficiaries who were in a PDP during all four annual open enrollment periods from 2006 to 2010 did not voluntarily switch plans in any of the enrollment periods.4"

Click here to read the entire report

Court Rules Workers Comp Must Cover Medical Marijuana

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An injured worker who was prescribed medical marijuana by a doctor will be covered by worker’s compensation, the New Mexico Court of Appeals ruled.

Gregory Vialpando claims he experienced severe pain after failed spinal surgeries to fix a back injury he suffered on the job.

He met the threshold for payments under workers' compensation laws and his doctor recommended marijuana to manage his pain.

The appeals courts decision upheld a lower court ruling that found Vialpando’s participation in the New Mexico Department of Health's Medical Cannabis Program constituted reasonable and necessary medical care, which is the standard for reimbursement under the New Mexico Worker’s Compensation Act.

His employer at the time of the injury, Ben's Automotive Services, and its insurer Redwood Fire & Casualty argued that medical marijuana must be treated as a prescription drug and that the medical marijuana program isn’t a licensed pharmacist or health care provider.

The court ruled that "medical marijuana is not a prescription drug," and even if it were, "our analysis would lead to the same conclusion."

"Indeed, medical marijuana is a controlled substance and is a drug,” the court wrote. “Instead of a written order from a health care provider, it requires the functional equivalent of a prescription - certification to the program. Although it is not dispensed by a licensed pharmacist or health care provider, it is...

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Rutgers report: devastating impact of long term joblessness

Today's post is shared from northjersey.com
* Research finds that many who have been unemployed describe "devastated" lives
A Rutgers University study released today provides a grim, detailed picture of the severe impact that long-term unemployment continues to have on the lives of millions of Americans more than five years after the end of the Great Recession.
About one-third of the long-term unemployed workers — six months or more — in the study, based on surveys of unemployed and employed Americans across the nation, said they had been "devastated" and suffered a permanent change in their lifestyle by their jobless experience. The study, titled "Left behind: The long-term unemployed struggle in an improving economy," found that one in five workers laid off in the last five years are still unemployed. And it showed how far long-term jobless workers slip compared with employed workers.
Fifty-one percent of long-term jobless workers said they had a lot less income and savings than they did five years ago, while only 23 percent of employed workers said they had suffered similar economic damage, the study found.
Sixty-one percent of the long-term unemployed said they did not expect their finances to improve in the next five years, the study found. That was about 11 percentage points higher than the assessment by employed workers of their finances over the next five years.
"While the worst effects of the Great Recession are over for...
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A Cancer Battle We Can Win

Today's post is shared from nytimes.com
THE war against cancer can be confusing, with providers, insurers and policy makers debating the effectiveness of treatments, prevention programs and research. But there is one significant victory within our grasp. There is, increasingly, a consensus that CT screening for lung cancer can save thousands of lives each year.
Lung cancer, the No. 1 cancer killer, claims the lives of approximately 435 people in the United States every day. In fact, more women die of lung cancer each year than breast, ovarian and uterine cancers combined. While lung cancer is curable with surgery in its early stages, most people are given diagnoses of lung cancer after symptoms develop, when the disease is often advanced and resistant to treatment.
Now, however, there is good evidence that we can reduce the number of people who die of this devastating disease. A recent study called the National Lung Screening Trial proved that we do that by using a low-dose CT scan to detect early stage lung cancer. The study showed that in older people, both current and former heavy smokers, annual screening reduced the number of deaths from lung cancer by 20 percent.
Dozens of medical organizations, including the United States Preventive Services Task Force, now recommend CT lung screening for high-risk individuals. Approximately nine million Americans meet the task force’s criteria for high risk: current smokers between 55 and 80 who have smoked, on average, at least one pack of cigarettes a day for 30...
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Those Lazy Jobless

Today's post is shared from nytimes.com
Last week John Boehner, the speaker of the House, explained to an audience at the American Enterprise Institute what’s holding back employment in America: laziness. People, he said, have “this idea” that “I really don’t have to work. I don’t really want to do this. I think I’d rather just sit around.” Holy 47 percent, Batman!
It’s hardly the first time a prominent conservative has said something along these lines. Ever since a financial crisis plunged us into recession it has been a nonstop refrain on the right that the unemployed aren’t trying hard enough, that they are taking it easy thanks to generous unemployment benefits, which are constantly characterized as “paying people not to work.” And the urge to blame the victims of a depressed economy has proved impervious to logic and evidence.
But it’s still amazing — and revealing — to hear this line being repeated now. For the blame-the-victim crowd has gotten everything it wanted: Benefits, especially for the long-term unemployed, have been slashed or eliminated. So now we have rants against the bums on welfare when they aren’t bums — they never were — and there’s no welfare. Why?
First things first: I don’t know how many people realize just how successful the campaign against any kind of relief for those who can’t find jobs has been. But it’s a striking picture. The job market has improved...
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