October 8, 2019
Not Giving Up on Healthcare
by Paul Carroll
When I wrote two weeks ago about the possibility of combining workers comp with health insurance to produce a sort of let’s-just-keep-people-healthy approach, many of you wrote to tell me that I’m nuts. (You were as kind as possible; thanks for that.)
One wrote that the obstacles to a combination are “nearly insurmountable.” She added:
“Workers comp is a legal system, whereas health insurance is a purchased benefit. Moreover, the legal system governing workers comp is federal law interpreted by each state, thereby making it 52 different legal systems counting Washington, D.C., and Puerto Rico. That’s the basis from which you need to start. Good luck!!”
I love the “Good luck!!” But I don’t give up easily. I still believe in Stein’s Law, which, paraphrased, says: “Trends that can’t continue, won’t.”
The trends in our intertwined healthcare and insurance worlds simply can’t continue. As a result, I think silos will break down, eliminating all sorts of traditional barriers, whether between workers comp and health insurance or between other parts of our healthcare system.
The urgent need for change was driven home by the recent report that the cost of family health coverage now tops $20,000 a year. That cost isn’t sustainable. Indeed, many people are dropping coverage because they can’t afford it.
The need also hit home in a more personal way. A woman I know, a CFO, reacted horribly to a cleaning solution used in her office and is largely incapacitated. She just wants to feel better and get back to work, but the lawyers have to sort this out first. Does she have a workers comp claim? A health claim? Is there a liability claim against the cleaning service?
In all, the American healthcare system spends 8% of the total on administration, compared with 1% to 3% in other developed countries.
But there are also signs of progress, of people trying to change the rules. In particular, businesses are starting to intervene to serve their employers better, beyond just paying for insurance. Amazon is following a move taken by many other large employers and setting up health clinics for employees, with an idea to rolling them out more broadly. Walmart is helping employees find doctors, schedule appointments and generally navigate the health system, also with the idea that the company might offer the service to others. Many companies are providing telemedicine services to help employees get faster, more effective treatment, supplementing the care provided through health insurance.
Even health insurers, the bogeyman for many, are moving more directly into care. That may or may not turn out to be a good thing, but certainly represents a blurring of traditional lines.
One of my favorite dicta from my days in Silicon Valley is: “Never confuse a clear view with a short distance,” so I realize that my (reasonably) clear view of healthcare won’t necessarily happen soon. In fact, I’d say it’s highly unlikely to happen soon. But it will happen, and we might as well get started, if not on workers comp and health insurance then on any number of the other possibilities.