WHY IS UNIVERSAL HEALTH

CARE AN OCCUPATIONAL

SAFETY AND HEALTH ISSUE?

Michael B. Lax MD MPH 3/26/18 The likelihood of these problems being fixed is virtually zero within the confines of the current WC system. The many forces driving doctors in the community out of the WC system remain, while the system seems unable and/or unwilling to institute countermeasures to keep physicians participating, let alone bring back practitioners who have already left. Meanwhile the abusive behavior of the WC insurance carriers continues unabated with challenges to every aspect of care provided by physicians including: diagnoses made, testing requested, and treatment recommended. Not only does this place a tremendous burden on the doctor and her/his office, it also prevents the practice of high quality medicine. The Workers’ Compensation Board ( WCB) and legislature have likewise failed to confront and curtail the powers of the insurance industry. If they can’t be fixed then why bother writing about these problems? Because if we look beyond the confines of the existing set-up there is a simple solution: universal public health care. A system such as Ontario’s single payer program resolves these issues. The division of health care into two parallel systems, one for general health and one for work related health problems, is a consequence of the US’ peculiar history. Workers’ Compensation systems were created in one state after the other in the decade or so following the Triangle Shirtwaist fire in Manhattan in 1911. Labor and its allies had been arguing for some time for a system to quickly and fairly provide medical care and compensation to injured workers as a replacement for workers having to sue their employers. Workers filing suit occasionally won significant sums, but for the vast majority the process was extremely burdensome and the barriers to winning a case made it very difficult for an injured worker to prevail. The sight of 146 bodies piled up near blocked exits and on Greene and other surrounding streets after the Triangle Shirtwaist fire galvanized reformers and gave the necessary push to pass Workers’ Compensation legislation. By the time general health insurance became widespread and often employer based in the following decades, the Workers’ Compensation system was already well established. Participation by physicians in WC is voluntary and a significant section of MDs has always chosen not to accept WC. In the past their reasons have included: low reimbursement, delays in payment, excessive paperwork, and demands to testify in court. WC underwent a significant reform in NY in 2007. As these changes were implemented incrementally over the next few years, many more physicians exited the system. The perceived increased demands of the reforms were the straw that broke the camel’s back and led many practitioners to declare “enough!”. As a result injured workers, especially outside the larger urban centers are unable to find doctors to treat their work related condition. Even those with doctors who have been treating them under WC often find themselves out in the cold as their physician informs them that s/he no longer will be accepting WC and will stop providing their care. A single payer universal health care system could address the problem of participation quite simply. Private health insurance and WC insurance would be eliminated, to be replaced by a government entity that would be responsible for financing all health care costs: a single payer. All patients would be covered for all health conditions. All health care providers would participate and provide care to all without needing to concern themselves about the work relatedness of a health problem. The issues of WC reimbursement rates, delays, paperwork, and court testimony become non-issues in a universal health care system, removing the disincentives MDs face in under the current system. Universal health care would also resolve the issue of poor quality care under WC as a consequence of insurance carrier abuse. In a single payer system the rules of what is approved and reimbursed are the same, whether a condition is work related or not. This is not to say the system is dispute or delay free, but there are far fewer than under the current system in the US. In addition, there is only one level of care, in stark contrast to NY where the health care received under WC is subject to so many challenges and barriers erected by the insurance carriers. The resolution of these key issues with a universal single payer system is not just theoretical. Just across the border in Ontario, for example, a single payer system has been in place for decades. There, injured workers have no problem finding a doctor to get treatment. They do not have their testing or treatment delayed, interrupted, or blocked altogether by a WC insurance carrier. Instead, the treatment they receive is the same any other resident would be provided, whether or not the condition is work-related. Ontario and Canada is just one example of how the system has already proven itself. Many others could be found across the developed world. Advocacy for single payer universal health care in the United States has been going on for decades. There is a tendency for politicians of both major parties to dismiss it as a possibility, Republicans mostly because they are opposed on ideological grounds to what they call (inaccurately) ‘government’ based medicine, and Democrats because ‘it’s just not realistic’. In the current Trump and Republican dominated administration it might seem like a pie in the sky goal. HOWEVER…popular energy in favor of universal health care has arguably never been higher. Bernie Sanders’ campaign made the issue a central plank of its platform, generating widespread support. He and many others continue to press for this kind of change. With popular support continuing to rise, the deficiencies of the current market- based health care system becoming ever more obvious, and the lack of any credible Republican alternative, there is legitimate reason for optimism for single payer. In the meantime, the New York State Assembly, led by Assembly Health Committee chair Richard Gottfried, has succeeded in passing the New York Health Act, legislation for the establishment of a single payer universal health plan for all New Yorkers, the past three years. Every year support has increased in the Republican controlled state Senate and last year was just one cosponsor short of majority support. In this context, it is no longer unrealistic to think that the New York Health Act could soon pass the New York legislature. As it stands now, the bill does not include health care currently provided under Workers’ Compensation. Its sponsors, however have expressed an openness to eventually wrapping WC into the system. Passing the New York Health Act is a crucial step on the road to changing the WC system and providing for the medical needs of injured workers. Health and safety advocates should see this as a top priority for our action agenda. And hopefully we can convince other advocates for New York Health of the importance of including the WC piece as a necessary part of truly providing universal health care in New York State. Inclusion of medical care for injured workers in New York Health should, however, not let employers off the financial hook for the responsibility they bear for working conditions causing worker injuries and illnesses. Injured workers and their families, and taxpayers already pay a high proportion of the costs of occupational illness and injury. To avoid socializing what should be the employers’ responsibility even further, New York Health should explore options for making sure employers pay their fair share, and include an effective mechanism in the universal health care system to be created. The following resources are useful for anyone seeking more information: Campaign for New York Health Focused on the campaign for universal single payer health care in NY state http://www.nyhcampaign.org Healthcare NOW National coalition campaigning for federal single payer legislation and support for state plans https://www.healthcare-now.org/about/ Physicians for a National Health Program (PNHP) National organization of physicians, medical students, and health care professionals advocating for single payer. Their site has a lot of data on all aspects of the issue. The PNHP Metro chapter has been supporting the campaign for New York Health http://www.pnhp.org http://www.pnhpnymetro.org Bernie Sanders This site describes his support for federal single payer legislation https://berniesanders.com/medicareforall/