Here’s some of the good stuff happening these days…

The number of workers with paid sick leave has jumped…lowest-wage workers’ access to paid sick leave has nearly doubled from 20% to 39% since 2010 – driven by more states enacting paid sick leave laws, according to a new Economic Policy Institute report. Overall, almost 4 out of 5 U.S. private-sector workers have paid sick leave, up from 3 of 5 in 2010.

Home care workers’ pay is going up...almost every state has bumped up wages for home care workers, a long-needed change that might help ease the hone care staffing crisis.

Know those yellow pill bottles that have been around forever…and will be around almost forever? Almost 200 billion are added to landfills and trash every year… CabinetHealth is pioneering recyclable – and refillable – glass pill containers…a way better way to get your meds.

Ok, leaving aside the obvious positivity – this is definitely facepalm worthy…there’s this NEW THING among Gen Z’ers...a “silent walk”…aka going for a walk without your phone!!

Who woulda thunk it? Just…walking? And yes, a TikTok’er discovered this revolutionary new idea, and it is…trending!!!

Next up…Silent Walking athleisure wear, shoes, hats, and rain gear, maybe logo that says “don’t disturb – Silent walking”.


Good news Monday starts with this from the Economist, a beacon of objectivity (reformatted for clarity):

a steady stream of better-than-expected data has left analysts scrambling to lift their forecasts.

    • New orders for manufacturing firms reached their highest in nine months in July.
    • Retail sales were perky last month, too, with consumers splurging on everything from restaurant meals to online shopping and clothing to sporting goods.
    • The construction industry has also been buoyant, supported by a rebound in homebuilding.
    • the labour market… has remained hot, making it relatively easy for people to find work at decent wages.
    • The total number of jobs in America has been growing faster than the working-age population, helping to keep the unemployment rate at 3.5%, just shy of a five-decade low.

Oh, and those naysayers, remember they are the ones who’ve been doomsaying a recession is imminent…for more than two years.

“Eventually” that may happen – and “eventually” my granddaughter may have grandkids…

Oh, and our economy has far outperformed the rest of the developed world over the last few years.

One measure of a country is how it cares for the less fortunate…thanks to recent changes in Medicaid thousands of homeless people are now getting primary care, which is:

A) the right thing to do and

B) saves a boatload of dollars as these homeless folks are far less likely to go to the ER which costs a shipload more than getting basic primary care.

What does this mean for you?

Don’t get caught up in all the negativity…workers are doing better and better, jobs are plentiful, we are improving the lives of the less fortunate…and the US is leading the world.


Awful news Friday

I wrote the post below 4 years ago…and I’m heartbroken that it’s truer now than it was back then.

Our daughter went to school near Lewiston…I’m heartened that she graduated years ago and guilt-ridden that other parents and family are terrified their kids and family members may be the next victims.

It’s easy – and completely wrong – to say it’s all random.  It isn’t.

At all.

The epidemic of death by firearm is uniquely American.

Take responsibility.

  • Demand red flag warnings.
  • Demand assault weapon bans
  • Demand universal background checks. 

Or accept the blame.

Guns and public health

Guns are a major public health and safety problem. Guns are associated with tens of thousands of deaths every year, most preventable.

And we Americans are among the world leaders in death via firearm.

Before you make any assumptions – I own guns. I hunt – although I’m a pretty poor hunter.

My dad taught me to shoot, and handle firearms, and gun safety. Among the guns I own are his service rifle – a 1903 Springfield – from WW2 and the revolver he carried while flying in B-17s over Europe. They mean a lot to me, and one day I’ll pass them down to my kids.

A couple key factoids that are worth considering.

  1.  Most Americans – and most Republicans – want background checks and “red flag” laws.  And most Americans want stricter control of gun sales in general.

2. Firearms are used to commit far more suicides than homicides.

3.  People who attempt suicide with a gun are much more likely to die than those who use other means.

4. There’s a strong correlation between higher rates of gun ownership and higher suicide rates.

5.  Lastly, every day 65 people use guns to kill themselves.

Guns are a major public health concern, yet no other public health menace gets the same public support.  As a gun owner, I’m deeply troubled by the willingness of some to advocate positions that will get more guns into more hands – which will lead to more unnecessary tragedies.

What does this mean for you?

The data is clear – people want stricter gun laws – and for very good reason


Medical costs are going up because…

Wonder why that office visit/imaging study/minor surgery/diagnostic test costs twice what it did last year?

Partly/mostly because the physician practice was acquired by a health system or big hospital…which – under current Federal law – allows the new owner to upcharge for “facility fees.”

VERY briefly, way back in 1997 Congress passed the Balanced Budget Act, a giant bill that, among other things, allowed facilities to tack on a facility charge for services delivered in its facilities.

That oversight is a key reason health systems have been snapping up provider practices as fast as they can, paying gazillions for primary care, specialty care, imaging, PT, you name it. (another key reason is health systems want to own as much of the care delivery and referral process – and fees – as possible)

This from Health Services Research:

Medicare reimbursement for physician services would have been $114 000 higher per physician per year if a physician were integrated [part of a health system] compared to being non‐integrated.

The differential varied greatly by type of service…

The solution seems pretty simple…to quote Health Affairs,

Pay for common ambulatory services under the rates, codes and policies in the physician fee schedule regardless of location

There’s an effort underway to at least partially remedy this by moving to a site-neutral reimbursement…but as it will take Congressional action that is a heavy lift indeed…especially given the current House of Representatives.

What does this mean for you?

Two things…

  • Think through potential unintended consequences BEFORE its too late
  • Rethink network contracting strategies…lock in pricing with office-based practices.


Yay North Carolina!

The Tar Heel State is the latest to expand access to Medicaid, a move that will drastically improve the health of 600,000 (!!!) North Carolinians and financial stability of dozens of hospitals and hundreds of other care providers.

40 states have now expanded Medicaid under the Affordable Care Act (aka Obamacare)…holdouts include Florida, Texas, Mississippi, Alabama, Missouri…

Think this doesn’t impact workers comp?

Think again.

States where work comp facility costs have risen the most – courtesy WCRI.

This from Captain Obvious – Hospitals in states that failed to expand Medicaid are using workers’ comp as a financial lifeline.

What does this mean for you??

Failing to expand Medicaid is unconscionable.  It greatly improves the health of babies, moms, kids, and older folks – at very, very little cost to taxpayers. 

The blatant hypocrisy of politicians claiming to respect life while blocking Medicaid expansion is disgusting.


Medical debt is crushing Americans

One out of three adults has medical debt. 

For many, this has a major impact on daily life…

Medical debt can be a huge obstacle, preventing families from buying a home, purchasing or leasing a vehicle, even paying for college for their kids.

That’s because credit bureaus include medical debt in their scoring algorithms. 

Looks like that will be changing…

From the Vice President:

The Consumer Financial Protection Bureau will propose a new rule to make clear that medical debt cannot impact the credit scores of the American people.  Once this rule is final, it will mean, one, that

consumer credit reports will not include medical debt and, two, that

creditors will not be able to use medical debt to determine a person’s eligibility for credit. 

Almost 2/3rds of those with medical debt had insurance when they began treatment...a quarter of those had their claims denied.

What does this mean for you?

Help is on the way.


A gubmint shutdown and you

Joni Mitchell’s Big Yellow Taxi provides today’s lede…and for good reason. The handful of elected House members on the verge of shutting down the entire government claim no one will notice when the Feds are furloughed.


Here’s a very brief list…

  • Most inspections of hazardous waste sites and drinking water and chemical facilities would stop.

  • CMS will furlough non-essential workers, potentially delaying MSA processing

  • OSHA will shut down all but critical operations
  • FEMA has begun rationing its money, pausing about $1.5 billion in longer-term recovery projects to ensure it has enough cash on hand in the event of a major, deadly crisis

  • Workplace safety inspections would be reduced or, if the shutdown persists, potentially stop

  • New applications for Social Security will be delayed, affecting some claim settlement negotiations
  • In past shutdowns the E-Verify system (for employers to verify work status/eligibility) wasn’t operating, likely limiting new hiring
  • Major infrastructure projects would stop
  • The Community Health Center Fund (CHFC), which sends federal funding to health centers – could be halted, among others…patients would have to seek care elsewhere, further increasing the burden on hospitals.
  • Enrollment in clinical trials would be delayed or postponed
  • Grants for new clinical research would halt
  • Funding for Federal courts runs out October 13 (although some may be able to continue operating)
  • 10,000 kids would lose access to HeadStart  – and thousands of others would also lose daycare, impacting parents’ ability to work.

sources here, here, and here.

What does this mean for you?

After you’ve burned the place down, where will you live?


Medicare drug price negotiations – implications abound!

Medicare will negotiate drug prices, Big pharma’s really upset…AARP is really happy…what’s the REAL story?

Briefly…One of the key parts of the Inflation Reduction Act authorized Medicare to negotiate drug prices for 10 medications. Those 10 meds have been identified, and the howls of protest from big pharma are deafeningbut our profits!!!!!

chart credit arsTechnica

(Pharma is the most profitable sector in the economy with a gross profit margin double that of non-pharma companies)


for taxpayers, Congressional Budget Office (CBO) reports taxpayers will save $160 billion by reducing how much Medicare pays for drugs

for millions of Medicare recipients, drug prices and out of pocket expenses for those 10 drugs will drop by thousands of dollars…seniors currently pay up to $6,497 in out-of-pocket costs per year for these meds.

(due to the Inflation Reduction Act, starting in 2025 Medicare beneficiaries’ annual out of pocket drug costs will be capped at $2000)

for payers, the picture is pretty very complicated...netting it out, “these steps would lead to a higher MFP [maximum fair price] and less or no impact on the drug’s…commercial net prices [after rebates]…” [emphasis added]

lest you feel sorry for big pharma, you should know that the ten medications are “older drugs and drugs that have really been blockbusters in the Medicare program. So the companies that have made these products have really reaped handsome profits from those drugs for many years, before they’re even eligible for negotiation.” cite

oh, and about Pharma’s complaint that this will hamper innovation, experts disagree…overall changes to Medicare’s Part D drug program “will probably have a positive impact on drug innovation, especially in areas that address the unmet health needs of high-cost Medicare beneficiaries”


VERY excited to announce a new ManagedCareMatters feature!

This incredibly prestigious award is strictly limited to one per month…so the competition amongst state legislators and regulators is BRUTAL.

So many aspire to the prestige and national recognition that the D/LRM brings that hundreds tirelessly beaver away, busting their humps to outdo the knuckleheads across the State Line, steam coming out their ears as they scribble away at the whiteboard, even calling on ChatGPT when their abundant natural intelligence doesn’t meet the mark.

This month it goes to…


Congratulations to the Great Potato State! As of July 1, Idaho became the only state without a specialized committee to review deaths related to pregnancy!!

The [now-defunct] Maternal Mortality Review Committee, or MMRC was composed of a family medicine physician, an OB-GYN, a midwife, a coroner, and a social worker – and others. Data collected and analyzed by MMRCs is used to:

more fully understand the circumstances surrounding each death, determine whether the death was pregnancy-related, and develop recommendations for action to prevent similar deaths in the future…

(sounds kinda Pro-Life to me, but hey! whadda I know?)

The legislators who decided to sunset the committee weren’t available for comment, although one has to respect their bold, Pro-Life commitment to not helping figure out why moms are dying!

It’s even gutsier when one considers that two Idaho hospitals just announced they will no longer provider maternity care, AND OB/GYNS are leaving Idaho, AND the state has among the most restrictive anti-abortion laws in the country…(state law prohibited termination of ectopic pregnancies, which are never viable and can be fatal if not treated. This specific prohibition of this Pro-Life Legislation was later overturned by the State Supreme Court).

Despite Idaho’s pregnancy-related mortality ratio of 41.8 pregnancy-related deaths per 100,000 live births in 2020, a third higher than the nation’s (already very high) maternity mortality rate, legislators determined the Committee’s $15,000 annual cost was far, far too much to spend…even though it was entirely funded by a Federal Grant.

The de-funding/killing off of the Committee by Idaho’s Pro-Life Legislature to save Idaho taxpayers…nothing! sets a VERY high bar for other legislators…kudos to the Idaho Legislature for their undying commitment to…dying.

Footnote – 75 of 117 Idaho OB-GYNs recently surveyed by the Idaho Coalition for Safe Reproductive Health Care said they were considering leaving the state. Of those, nearly 100% — 73 of 75 — cited Idaho’s restrictive abortion laws.

The inaugural award sets a high bar indeed…

What does this mean for you?

Get to it you aspiring DL/RM recipients!


How much is too much?

The average family of four’s healthcare insurance and related costs are more than $31,000.

Which begs the question – how much is too much?

At what point do workers, employers, taxpayers make that call?

Because it is going to happen.

Look at your budget, your income, your future expenses…when does healthcare become unaffordable? a quarter of your income? a third?

Sure, you aren’t paying the entire $31k…

  • your employer pays a big chunk,
  • taxpayers subsidize employee benefits so
  • taxes are higher due to that subsidy,
  • but your deductible/coinsurance costs are likely several thousand dollars.

What does this mean for you?

I’d ask you to think hard about this – because we will all have to make this choice.

Sooner than we’d like.