Healthcare 2020

Health Care 2020

By James D. Tippett

To view the debate surrounding health care it is useful to project the future, ala Alvin Toffler. Health care in 2020 will be viewed as a carefully manipulated plan, so global in its impact that no one envisioned the scope or the speed with which the control was implemented. Looking back we will realize how crafty politicians found it so simple to assemble all the discrete pieces, Bill by Bill to lock in their Socialist vision. Once done, it became an intertwined network of such a pervasive nature that it could never be undone.

Health care legislation passed easily through the partisan House in late 2010 despite the unrelenting objections of constitutional patriots, who as if enabled with psychic ability, foresaw the devastation on the horizon. Many citizens still were unclear of the implications of the shift or who was telling the true story, but with so many citizens out of work, the promise of affordable health care quelled their objections and dulled the forecast of socialistic impacts. Once passed however it quickly became evident, much like a fly into the spider web, that it was about much more than a humanitarian effort.

In the beginning it appeared benign enough, those who had health care, kept it, and those who did not got signed into the Social Health Insurance Trust. Now confident of public support, or non defiance, Congress was bolstered with the passage of another masterfully planned Bill, though few could recount all the provisions.

Shortly after the passage of health care legislation, it was discovered that a last minute addition to the Bill mandated newborn health screening; Politicians who had been bombarded by parents of children with afflictions, pleading to make testing for all children mandatory, felt compelled to listen to their constituents . Indeed, many children were afforded treatment options at early ages to lessen the impact of their genetic malformations. An added benefit by some views was that these tests also showed promise as being predictors of predisposition to other health and mental afflictions that had been ravaging our health care system, such as heart disease, cancer, depression, obesity and even halitosis. Multiple benefits were also gained in that to concoct an accurate picture of the child’s genetic composition the parents also were “screened”. How wonderful to have this advanced knowledge of our individual futures. The ability to know whether or not to save for retirement or your child’s education was wonderful and enhanced the life of many who now knew that they had better have fun while they can.

Then as if by coincidence, Bills mandating a national system of easily accessible and searchable electronic health care records, touted as the great cost and life saver by the medical community, passed quickly. Databases strained as they started filling up within the government. How wonderful to have these people segmented in databases, drawn from the hard drives of medical providers holding previously confidential medical records. The public hardly noticed this transition as it was suppressed in the media due to national security implications as the U.S. Military was now solidly engaged in North Korea. Besides, the information was going to the Government so confidentiality did not seem like such a big deal, and they already had our social security number anyway, right? Medical providers readily transferred the data, a prerequisite to apply for the numerous government health care funding and grants. There was little incentive for not sharing this information and the threat of audit and fines for non compliance were well known.

Commercial health insurance companies, pressured to lower costs to remain competitive, lobbied Congress to allow them access to the National database. Bolstered by the large campaign contributions which seemed virtually unlimited once the Supreme Court struck down the restrictions, Congressional members did not see this as that onerous of a request once the check cleared. After all, it would enhance the insurance companies’ ability to provide more efficient and cost effective care. Oh, and save lives.

With this new found stream of information commercial health insurance company actuaries went to work. They began evaluating the “status” of the employee’s that their Policy Holders employed. Small businesses and sole proprietors, now one of the largest segments of the economy, were also of particular interest as they were less likely to have employee wellness programs or sufficient hiring or safety practices. They found the data from the new born screening and immigration databases to be of particular benefit and the most comprehensive source of predictive modeling data. Of course, the individual employee would need to authorize and sign a release to allow access to these records. Pressured by their insurance companies with the promise of premium savings, employers made these releases a condition of employment.

Sophisticated computer software scanned the databases continually, at first identifying only an organizations cumulative risk exposure that allowed for more accurate annual premium determinations, and the formation of more competitive quotes. Soon the benefit of an even more detailed analysis became evident. Insurance companies found that if they utilized a Sequential Contributor Review and Evaluation Workup, they could calculate precise premiums to be more reflective of exposures presented by any individual within the target group, and adjust premiums accordingly. Employers rebelled against this as they felt they had no control over an employee’s personal habits or their genetic predisposition. Insurance companies were unyielding and only provided two options. First, the company could find coverage through the Social Health Insurance Trust or exclude selected employees from coverage, and direct them to the Social Health Insurance Trust.

Companies were reluctant to sign in to the Social Health Insurance Trust as it was difficult to attract top talent with this coverage option, as liposuction and cosmetic surgery were seldom covered. In addition, expenses related to the numerous government mandates, administrative tasks and reporting requirements actually outweighed the premium savings gained when companies left the commercial insurance companies. Excluding certain employees with negative medical indicators, such as high blood pressure, obesity or a history of psychological counseling, gained ground as a realistic solution. Additionally, companies found that if they also excluded those employees showing a genetic predisposition to any number of ailments they could further lower their expenses. This is not viewed as draconian since the employees are simply rolled into the Social Health Insurance Trust as mandated under a Friday afternoon Congressional session that passed this amendment to the legislation.

Once the employees are in the Social Health Insurance Trust, they find that there are numerous resources available to them. The government completes its own Sequential Contributor Review and Evaluation Workup for each individual entering the Trust. Given that this coverage is now funded by the public, the Government has implemented an oversight administration that is responsible for overseeing the Social Health Insurance Trust centers and in setting the requirements for the individual care plans under which individuals will be bound. This is wonderful in that an obese person can be placed on an exercise and diet regimen to reduce their weight, their health risk and thus reduce the cost exposure to the Social Trust. Similarly an individual’s alcohol consumption, participation in at risk hobbies, and even driving habits can be monitored to reduce the risk exposure to the Social Trust.

Congress touts the success of the program in reducing obesity and the death rate. New legislation is introduced and passed that extends the program to include people with genetic predispositions under the Care Plan Requirement. The software again hums through the databases driven by these new search criteria. Lists print flagging individuals with potential predispositions, family histories and other perceived mutations. These individuals are also bound under the Care Plan Requirement and prescribed precautionary pharmaceuticals, counseling and periodic monitoring.


It soon becomes evident that compliance with the stipulations in an individual’s care plan is difficult to monitor. So to, requiring regular monitoring visits to the Social Health Insurance Trust centers is costly to the system. Something must be done. In response Congress enacts the Community Health Issuance Program whereby an individual pays an additional premium, through payroll deduction, to account for the higher risk they bring to the Social Health Insurance Trust. Participants can take advantage of the automated monitoring provision of the Community Health Issuance Program by having a small RF monitoring device implanted painlessly behind their ear, resulting in lower premiums. It’s a wonderful world.

By the year 2030 the problems are insidious. The Social Health Insurance Trust, burdened by a pool of medically dependent citizens and a diminished tax base is starting to crumble. Companies have stopped hiring individuals flagged as risks in the national databases, thereby adding them to the public tax burden. A system of health credits is instituted whereby unemployed individuals are allocated a set number of transferable credits calculated by risk and other factors such as adherence to their Care Plans. To decrease the stress to these individuals, Care Plans are amended to include medications to reduce anxiety, which were also fi=ound to quell dissent. Individuals unemployed for more than three months are automatically enrolled in the Community Health Issuance Program and fitted with the comfortable monitoring devices. Criminal law is modified to include penalties for non compliance, those who do not submit to the monitoring are fined and /or detained.

Fortunately, genetic engineering is showing promise and newlyweds are offered premium credits to seek genetic counseling before having children. End of life counseling has indeed produced the intended result saving billions in unnecessary treatments. Start of life counseling is added to the legislation that mandates start of life counseling when genetic defects or predispositions are found in newborns. Parents are encouraged to consider the quality of life and added costs that must be bore given the increased premium rates, or additional health credits needed to offset the increased exposure to the social system. With birth defects in children plummeting, and similar statistical results being seen across the medical care continuum, the program is celebrated as a success.

You decide – Fact or Fiction – If nothing more, a cautionary tale
Originally published September 16th, 2009 - The prophesy keeps turning into reality me thinks...

What's Wrong with Safety

Introduction

Perhaps the best indication of what’s wrong with safety is the time I spent wrestling with myself over the name of the book. Would anyone, unless they were forced to in a college course, actually buy a book on safety, let alone a book on what’s wrong with it? (If you are sitting in a college class right now, bare with me, you will be glad you did.)

Safety is not sexy, and generally the poor schmuck who is in charge of the safety program is not well respected, and overall given little attention until something dramatic happens. Safety is typically viewed similarly to paying taxes, a necessary evil that if most executives could they would do away with, as many have. Yet again many who have completed their last plant inspection and employee training program may feel that they have their safety under control and that such a book is for the “others”. That may well be, but it is unlikely.

As I began writing this book, my intention was to bring to the forefront the frustration that I feel when I see, or hear of a senseless, injury or a death or tragedy. Why? Because in all, yes all, situations it could have been avoided. People where simply too busy, too rushed, lacked the knowledge, did not fully plan or evaluate, or downright did not care (for any number of reasons) to understand and take the proper precautions that would have protected their employees, themselves, their company, their customers, their friends or their family from harm. But who is to blame? Is it a particular company, their managers and supervisors? Is it the employees? Is it society, globalization, bureaucracy, the marketing industry, the film industry, my stupid neighbor, my mother, my father, my brother, my sister, and my favorite, the Lawyers? Depending on the situation, and who you talk to, all share a little of the blame. But why, especially when 20 / 20 hindsight is so crystal clear, do we continue to experience the oft times devastating results of so-called “Accidents”? Was the risk so small that no one felt the need to do anything? Did the costs outweigh he perceived benefit? Does the very word “Accident:” let everyone off the hook? Or was it simply not cool to be safe?

Many may react negatively to this book, especially those in the safety profession, and that is the intent. We all need to take a look in the mirror and understand why; overall, “Safety” is no more than an ethical buzzword. NO? Then explain to me why we are more concerned over 1,000 convicted rapists and murders being executed than we are over the more than 300,000 auto fatalities and 200,000 workplace fatalities, they are just as dead.

Nor do we worry about the 1,000,000-workplace injuries and the estimated 3,000,000 non-work related debilitating injuries, not to mention the environmental exposures (most likely unquantifiable, that happen every year in this country. This is not to imply that the premise of this book is global and all encompassing, yet it does point to a main premise that we can not evaluate safety in the workplace, without evaluating all these arguably contributing factors. Why is it almost deemed acceptable to have a certain amount of injuries, accidents, explosions, contusions, fires, crashes and yes fatalities, yet the nation is outraged over one husbands quest to put his vegetable wife out of her misery. What’s wrong?

Safety is also a rather mature field, not much new is going on, unless you are from the perspective of someone embedded in the safety profession who is constantly searching for the next promising silver bullet to slay the loss monster. Other than that, void major incident, safety just plods along in the background, an after thought. Every once in a while a new twist, a new flash, a new promise of zero accidents surfaces yet the message is often only received as a dim annoyance spurred by the threat of a fine, or the media focus of the day as executive rush to make the next deal, meet the next deadline, launch the next product, or build the next building. What’s wrong?

What I began to realize as I delved further into this book, is that the question “What’s wrong with safety?” actually has many implications and similarities to “What’s wrong with our Company?” This re-enforces one of my staunchest assumptions, that if you have safety problems, you have business problems. My Company, Tipson Enterprises, was launched by this realization and the belief that by focusing on the entire organization, we would not only have a much greater impact on eliminating or reducing the loss exposures at a company, but also impact the profitability of the company through reduced operational costs. Reducing operational costs by the way should not start with laying people off, unfortunately that does seem to be the easy thing to do, and ironically, one of the things that is “Wrong”.

The ANSI Z10 and the ISO 18000 standards hold much promise as they aim to move companies beyond compliance and into active management of safety just as they manage all other aspects of their business. Yet I have found few individuals outside the safety profession that have any knowledge of these standards. How these will truly impact an organizations “safety” will depend again on the implementation. A simple word, yet failed implementation is the primary reason why so many pages of safety procedures and “programs” reside on the shelves of safety and human resources departments everywhere. “Sure we have a program!” is the assuring exclamation. Yet regulations and programs do not prevent loss, people do. And herein lays the problem and the reason I intend on having a job for a long time. What’s wrong?

This is not written for the companies whose top brass has realized the importance of safety and demanded nothing less than a total, sustainable safety culture. However, given that those in this group account for roughly 2% of today’s US based companies, I feel we have a good bit of room for discussion on this topic. Does anyone wake up in the morning saying, “I don’t think I will be safe today!” or “I’m going to throw my shoulder out at work today so I can take the summer off!” well do they? The second one may give you reason to pause as a possible true statement, but generally we do not consciously intend to go to work and get hurt, or hurt others, yet we still do. What’s wrong?

There are countless companies and organizations that, at first glance have an adequate "program" in OSHA’s eyes, yet fail to realize the savings and loss prevention that such programs are meant to provide. They are strictly compliance-based organizations doing what the regulations are trying to tell them to do. They also fail to see the connection to their bottom line profitability, not just from potential savings on their insurance premiums, but from the improvements in the core process of their organization, where the true financial rewards lie. What’s wrong?

Why isn’t there a national outrage for every workplace fatality, every auto crash that results in a fatality, every fire that results in a death, and every product defect or misuse that results in injury? These people were very alive and most living happy productive lives, yet there is barely a head line outside the local community were the incident occurred unless there is some kind of extended drama that the media can react to, like miners being trapped in a mine after an explosion. WHAT’S WRONG DAMMIT?

Rights reserved James D. Tippett, MBA, CSP, ARM

www.tipsonxl.com