New Approach to Health Care Reform

One of the Google Alerts to which I subscribe is “health care reform,” which seems to offer the liveliest discussion of late of any topic I subscribe to.

For obvious reasons, of course, what with our incoming president putting health care on the top burner (right below economic stimulus, I would imagine).

Everyone in what I read seems focused on how to maintain the current system of private insurers and private medical practitoners while somehow incorporating another 47 million people into the ranks of the insured.

However, as students at the Harvard Business School pointed out in their blog, where are the doctors going to come from to handle these millions? They describe how, even in their home state of Massachusetts, getting everybody insured is not the same thing as getting everyone in front of a doctor. The American Medical Association (AMA), they note, paints the current physician shortage in the U.S. at between 35,000 and 40,000 practitioners.

That’s number one.

Number two is even more interesting, and it concerns the medical delivery system itself. I’d never really thought about this aspect before, until I read an article in the Anchorage Daily News. In that article, Dr. Doug Eby, a senior administrator with the Southcentral Foundation, which runs a medical center in Anchorage for native Americans, compares the current system to car repair: Come in, be diagnosed, get your fix (pill or procedure), and get out of my face until you break down again.

In reforms carried out by Southcentral at its Alaska Native Medical Center, Eby and others have changed the whole focus, so that patients are now considered “customer-owners,” and they don’t necessarily see a physician for every complaint or symptom. They see whomever is most helpful and attuned to their situation. For instance, people with diabetes (after the diagnosis by a doctor) will work with a nutritionist and perhaps a behavioral counselor or other people who can set up a diet-and-exercise program and then monitor it to ensure its success.

Also, everything is contained within the one facility, so that customer-cowners can walk from the nurse’s or doctor’s station over to the x-ray room or blood lab. Everything gets done at once.

The results have been fairly stunning. In the ten years since the Alaska Native Medical Center has adopted this new delivery system, emergency room and urgent care visits are down by 40 percent, specialist visits by 50 percent, and hospital days by 30 percent.

Efficiency and a more holistic approach seem to be paying dividends (although no one mentioned any proof that people are healthier or that the mortality rate is down).

I think Dr. Eby and his colleagues are onto something big here since a lot of what ails us we bring upon ourselves by unhealthy life choices (smoking, eating too much and too much of the wrong things, not exercising, and the list goes on).

Maybe number two–changing our approach–will mitigate number one, a shortage of doctors.

Somehow, however, I can’t see the politicians in Wsahington, D.C., being anywhere near smart enough or caring enough to consider something like this. They’ll do whatever gets them the most votes, and then drop the whole system on a bunch of bureaucrats to run.

Business as usual in the nation’s capital and in medical centers everywhere. The lines and the waits will just be longer, much longer.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Straight Out of Dickens: Labor Strife in China

You might think it was the early phase of the Industrial Revolution in Great Britain if you visited South China these days.

Guangdong Province is the manufacturing heartland of China, and its factories supply a lot of what we Americans find at Wal-Mart and many other retail stores, especially toys.

But things are getting tough in China, by many standards tougher than we have it here in the U.S.

First, under pressure from Wal-Mart and other large-scale buyers, China officially raised the minimum wage, but that didn’t stop Wal-Mart from simultaneously demanding lower costs. Profits, at least for the toymakers, sank immediately.

Then came higher fuel costs and now the recession in the U.S., and factory after factory in Guangdong began shutting down; factory hands were let go en masse, many of them migrant workers whose families back home in distant provinces depend on them for monthly cash infusions–and bare survival.

Since the beginning of 2008, some 3,600 toy factories have gone under, leaving hundreds of thousands without work, yet China still publishes an official unemployment rate of 4 percent.

Now, the workers are fighting back–literally. Dongguan, the city where the toy manufacturers are concentrated, has witnessed several episodes of laid-off workers’ occupying and trashing the factories after they’re closed. Riot police have been called in. Scenes have gotten ugly. Tensions are understandably high, as is anxiety for the future.

But since the owners of the factories often disappear into the hinterlands after closing shop, local authorities are usually powerless to collect back wages, let alone enforce severance packages. In some cases, the government–hoping to keep face–has itself coughed up the workers’ earnings.

As it stands, Chinese factory workers toil up to 80 or more hours a week (when times are good) for the princely sum of 770 yuan a month, about $118. Overtime is almost never paid.

In the States, we just witnessed the employee occupation in Chicago of Republic Windows and Doors, which was abruptly shuttered after Bank of America closed its line of credit to the firm.

The laid-off workers demanded 60 days’ wages and benefits under the WARN (Worker Adjustment and Retraining Notification) Act since that law requires firms to give 60 days’ advance warning of mass layouts (unless there is an unforeseen emergency, a gray area).

Just last night I heard that BofA was going to advance Republic a $1.2-million loan to remunerate the fired employees.

So, the employees won, evidently, but I have one question:

How is Republic going to repay BofA if it’s no longer operating the factory?

(I just learned, but I don’t know if it’s accurate, that the sum is actually $1.75 million and that it will go into a fund with money from both JPMorgan Chase and Bank of America. This would seem to indicate that it’s not a loan, but a publilc relations tactic to counter consumer and public ill will toward the banks.)


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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The Immaculate Recession: Men Feel the Most Pain

I call it “The Immaculate Recession” because our current turmoil seems to be solidifying what should’ve been obvious a long ago:  We are no longer an Industrial Revolution economy; we’re the Information Age economy, and in that area, we still lead the world.

That’s why, when one surveys the pain going around in 2008, it’s illustrative that 1.1 million men have lost their jobs this year while their female counterparts are enjoying a net gain of 12,000 jobs, according to the Labor Department.

Factory jobs are disappearing, and being robotized and mechanized, while Information Age jobs are growing.  We mustn’t overlook the health care sector either.  That was the source of 400,000 new jobs for women this year alone.

Anyway, you get the drift here.  As painful and unsettling as recessions are, they exist for a reason and ultimately lead to needed social and workforce changes.

It’s like the Chinese say when they want to curse you:  “May you live in interesting times.”


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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FMLA to Get Regulatory Makeover on Jan. 16

Mostly right, I guess, given the composition of the current administration.

Much indeed has been made of Bush’s so-called “midnight regulations,” which no doubt face reversal under Obama and the Democratic Congress, but one set of regulations looks to be ensconced for a while. That would be the Final Rule issued Nov. 17, and taking effect next Jan. 16, to expand and clarify the Family and Medical Leave Act (FMLA).

Since 1993, FMLA has afforded workers with health care and family needs the option to take up to 12 weeks of unpaid leave, either consecutively or intermittently. The Final Rule keeps this option intact but shifts more of the notification and certification responsibility to the employees themselves. For the first time, it even gives employers the right to verify the health provider’s certification of the employee’s condition and treatment, but only to the extent of verifying the provider’s signature and whether he or she actually issued the certification.

Too much on that already, but the main idea is that employers, after two years of input to the Department of Labor, got what they wanted in terms of ending employee (alleged or perceived) abuse of FMLA.

The other big part of the Final Rule is that it adds two categories of leave for relatives of service members. One category affords 26 weeks of unpaid leave to tend to an injured service member (certain conditions apply, of course), and the other category provides up to 12 weeks for certain “exigencies,” for instance, to join a service member when he or she is home on leave or when he or she is preparing to be deployed.

Unions and employee advocates are naturally cheering the military component but deriding the new employee notification and certification policies.

At any rate, it will take a long time to go about changing or reversing these new regulations and clarifications, though President-elect Obama has already announced he wants to expand FMLA to employers with just 25 or more employees in a 75-mile radius (down from the current 50). He also wants to pass legislation mandating that all employers allow paid leave.

We’ll just have to wait and see as a more employee- and union-friendly administration takes over, so we can then “fly left.”


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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FMLA, Minimum Wage Law Changes Abound in 2009

I won’t even begin to get into the changes to the Family Medical Leave Act (FMLA) coming into force on Jan. 16, 2009, but as many have mentioned, the FMLA Final Rule (registered on Nov. 17) is a boon to families of service members and to employers, the latter of whom now get a better structure for dealing with FMLA requests.

More on that perhaps another time.

For now, let’s look at changes coming to the minimum wage. In addition to Puerto Rico and the District of Columbia, 25 states will be raising their minimum wages in 2009, with Washington topping the list at $8.55. Compare this to the new federal minimum wage, which kicks in July 24, of $7.25

Incredibly, the two highest minimum wage laws are in cities, and both take effect Jan. 1, 2009. San Francisco is upping its minimum to $9.79 an hour, while Santa Fe is pegging its rate at $9.92 an hour.

I’ve heard some talk (probably wishful thinking) coming from Obama supporters of upping the federal minimum wage to become a living wage (in the neighborhood of $11 or so an hour). We’ll just have to wait and see on that one.

There’s also the little matter of the Employee Free Choice Act (EFCA), which would legalize unionization of a company by “card check.” As soon as more than 50 percent of employees sign these cards, zap–here comes the union to start negotiating.

EFAC, needless to say, has many employers more than a little concerned.

Again, more on that in a future post.

For now, thanks to Ann Barnes at the Compensation Force blog for compiling the list of 25 states’ raising their minimum wage.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Labor Law Changes Coming in 2009: A Preview

I‘ve been following the News Alerts and other features at Personnel Concepts and note that big changes are coming labor’s way next year even before the new president is sworn in on Jan. 20.

First, there are a lot of clarifications and updates to the Family Medical Leave Act (FMLA). For one, it now covers not only private-section employees but also service members’ families, allowing them up to 26 weeks of unpaid leave in certain situations. (Everyone else gets up to 12 weeks, which can be taken intermittently.)

The so-called FMLA Final Rule also tightens up employer and employee communication standards. Gone are the days when an employee could disappear for a length of time and return to announce s/he had been on FMLA leave. Everything has to be done just as sick days and vacation requests–no more disappearing acts. For further details, read this.

The new FMLA regulations take effect on Jan. 16, 2009, but on New Year’s Day we’ll all be greeted with the implementation of the Americans With Disabilities Act Amendments Act (ADAAA).

One labor lawyer whose advice I read announced, after reading the ADAAA, only half in jest that everyone now qualifies for a disability. From my reading of parts of the ADAAA, I would say that, yes, it’s now much simpler to seek “accommodations” for just about anything physical or mental. I just wonder how far some employees will go to test the limits of these workplace accommodations and looser definitions of disability.

For more details, read this.

Again, thanks to Personnel Concepts for keeping me updated on all these issues. The alerts and other information are all free at their Web site, www.PersonnelConcepts.com.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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Minimum Wage Laws in America’s Priciest Cities

Regardless of what you think of minimum wage laws (business owners generally hate them while workers and advocates generally favor them), it’s pretty hard to survive on a minimum-wage existence.

Consider this:  San Francisco and Santa Fe, two cities that maintain their own minimum wage laws (which are higher than both the federal and state wage standards), will raise their rates on New Year’s Day–San Francisco to $9.79 an hour and Santa Fe to $9.92.

I did a quick calculation on what these rates would guarantee a worker.  In San Francisco, $9.79 an hour would garner $391.60 per 40-hour week and $20,363.20 for a 52-week year.  In Santa Fe, the equivalents would be $396.80 a week and $20,633.60 a year.

As you can see, that ain’t much.  It would be hard even to rent a decent apartment and feed yourself on those wages given the high cost of living in both of those places.

However, that still doesn’t resolve the issue of whether minimum wage laws help or hinder the overall economy.

The standard saw against minimum wages has been that it prices the young, unskilled and undereducated out of the economy, thus leading to other costly social problems.  Of course, the argument inn favor is a basic one–if we didn’t guarantee a minimum wage, people would be forced to work for peanuts.

Of course, the way our economy is going, we may all be forced to eat peanuts soon enough, anyway.


NOTE: The details in this blog are provided for informational purposes only. All answers are general in nature and do not constitute legal advice. If legal advice or other expert assistance is required, the services of a competent professional should be sought. The author specifically disclaims any and all liability arising directly or indirectly from the reliance on or use of this blog.
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