Let's talk healtheare reform.(WORKERS' COMP)

Impress your neighbors with your perspicacity on national health reform by drawing on your knowledge of workers' comp. Here are eight pearls of wisdom to impart by the baekyard pool.

The workers' comp system covers about 130 million workers and costs about $500 per worker per year. Nonoecupational healtheare spending for 300 million people runs about $8,000 per person per year. Some would say that workers' comp is more focused and the levers to influence medical care are more graspable. Let's see about that:

1. Universal coverage. Except for the "nonsubseriber" employers in Texas, virtually the entire workforce in the United States is covered by workers' compensation laws and by insurance requirements. This limits the number of hard-luck eases and sharpens accountability. Score one for the workers' comp system.

2. Financial responsibility of the household. The injured worker does not have to pay any medical deductibles or copays. This may be the chief reason why medical care for work injuries includes more treatments when compared to identical nonoccupational injuries. The lesson: the patient should retain financial responsibility, within reason.

3. Employer-based insurance. In the healtheare policy debates, the tendency is to favor loosening the involvement of employers. The ease for employer responsibility for workers' compensation insurance is that employers profoundly influence safety, return-to-work and the cost of workers' comp.

4. Comparative effectiveness research. Its impact on the workers' compensation system has been positive but modest. Still, treatment guidelines are essential for all aspects of medical care.

5. Computers. Workers' comp is at least 10 years behind the healthcare system in using computers in medicine, from financial exchanges between providers and insurers to having patients use online self-management services. The workers' comp system is laden with pointless information requirements.

6. Encouraging collaborative medical care. We see better outcomes at lower cost when doctors work closely in diagnosis and treatment. Team-like cultures retard gaming and revenue-maximizing. This is why the Mayo Clinic, with its strong collaborative culture, delivers excellent medical care at relatively low cost according to comparative data. In workers' comp, carefully chosen and actively managed medical provider networks appear to reduce disability and medical costs.

7. Public insurer option. Liberals are eager to launch a publicly controlled healtheare insurer to compete with private insurers. They are more animated by their growling distrust of private insurers and (among some) hunger for a single-payer system than by any evidence that a government insurer can improve the competitive market place. The workers' comp system's 25 state funds variously perform better or worse than private carriers.

The California State Fund in the early 2000s helped to bring the state's workers' comp system to the brink of disaster by ruthless underpricing. A private insurer so behaving would have been taken over by regulators.

8. Healthy behaviors. Exercise and diet are correctly sold as preventive issues in healthcare. In the workers' comp space, exercise, diet and treatment for depression are positive factors in speeding recovery from injury. Wellness counts in both systems.

Now you really know a bunch about healtheare reform, don't you?

PETER ROUSMANIERE is an expert on the workers' compensation industry. He can be reached at riskletters@lrp.com.

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