It’s been a blissful few months as COVIDF has retreated into the background, likely to remain with us forever but hopefully as a nuisance not the million+ killer it was for the last couple of years.

So, two new items.

First, in what can only be described as a huge waste of taxpayer money, a very large and very scientific study found ivermectin does not reduce COVID symptoms. 

Shocking, right?

Details…

• double-blind, randomized, placebo-controlled platform trial
• 1206 US adults with COVID-19
• median time to sustained recovery was 11 days in the ivermectin group and 11 days in the placebo group.

Hucksters, charlatans, former US presidents and other of the willfully-ignorant will undoubtedly parse, lie, misstate, ignore, or otherwise continue to claim that a veterinary medicine for treating bacterial infections is actually a cure for a viral infection.

to quote a T-shirt recently spotted…

Lab leak, nefarious plot, or animal-to-human transmission?

Last week the new broke that the US Department of Energy thinks  – albeit with “low confidence” – that COVID leaked out of a Chinese lab.

This is sort of like saying “Tom Brady is going to sign with the Yankees as a pitcher…heard this from a guy I know who was on a plane sitting next to a woman who looked like a reporter and saw her writing that Brady’s heading to spring training in Tampa…”

This is NOT to disparage the scientists at DoE, rather to remedy what seems to be a serious lack of reading ability on the part of too many who can’t seem to grasp – or rather refuse to accept – that things are rarely black-and-white, or as friend and colleague Pier Rousmaniere notes in his signature line;

Doubt is not a pleasant condition, but certainty is absurd. – Voltaire

[Unless, of course, one has completed a rigorous 1200 person RDB – CT study]

Nine Federal intelligence agencies have completed their research on the “where did COVID come from?” question…Two of those concluded a likely lab leak, five said natural causes and two said they don’t know.

Given the really lousy record these state-of-the-art labs have when it come to keeping deadly viruses contained, it is certainly possible it leaked.

Reality is  – it is unlikely we will ever know – for certain.

What does this mean for you?

Read carefully before posting.

Last time we talked tanks…

This time we’ll focus on Russia’s winter offensive. If you don’t have time, just skip to the takeaways at the bottom of this post.

credit Institute for the Study of War; I highly recommend ISW’s briefings

Quick take – the offensive isn’t going well. While Russia is making advances, they are measured in meters not miles, and are coming at horrendous cost in dead, injured, and captured Russian troops. The Russians did capture Soledar and have make barely measurable progress around Bakhmut and a couple other places but none of those are – in any way – changing the reality on the ground.

Which is Russia is screwed.

As we discussed in WOT #10, you need troops and equipment to fight a war.

The Russians lost a huge amount of equipment last year – hundreds of tanks, armored fighting vehicles, cannons, trucks, trains – equipment it cannot readily replace, if at all. If you want to attack, as Russia is trying to do in its winter offensive, you really need armored vehicles to penetrate opponents’ lines and break out into less well-defended territory. Dug-in defenses  – usually several lines deep – are very, very hard to defeat unless you can blow a really big hole in them and exploit the opening with fast-moving vehicles.

So, in what is eerily reminiscent of World War One, Putin the Butcher is throwing thousands of untrained men at Ukraine’s front lines. (If you want a taste of that, I highly recommend the book and film “All Quiet on the Western Front“.) Trigger alert – it is really awful and disturbing, and the German general is a bald version of Putin the Butcher.

PtB’s tactics are pretty awful…

• untrained ex-prisoners and recruits from Russia’s far east are forced to attack Ukrainians positions.
• they are slaughtered – because they have no idea what they are doing, have minimal weapons and ammunition, and are going up against entrenched, battle-hardened and well-supplied Ukrainians, but
• in so doing, the Ukrainians reveal their positions, which are then bombarded with rockets and artillery and attacked by much more capable Russian troops.

That is NOT to say Russia’s “real” soldiers are invulnerable. Reports from the front indicate Putin’s “elite” units lost dozens of armored vehicles and hundreds of soldiers over the last few days…equipment and men which Russia cannot afford to lose.

Putin the Butcher has a seemingly inexhaustible supply of poor young men but they are a very poor substitute for modern military vehicles and artillery.

Takeaways

While others much more knowledgeable than I see this war grinding on for years, I’m hard pressed to agree.

Russia:

• cannot replace most lost equipment,
• is losing more and more of its irreplaceable, experienced and well-trained troops,
• has not demonstrated its generals have any idea what to do,
• is facing an increasingly better-equipped and far more motivated enemy, and
• is losing the information and intel dimensions.

Like we saw late last spring, all is well until it is not, and then it goes really, really badly for Putin the Butcher.

all previous posts on this topic are here.

Far too many work comp industry CEOs are dinosaurs.

Their refusal to adapt to today’s labor market will ensure they fail their investors/policyholders.

Two things triggered this post.

1. an extensive conversation – or rather series of conversations – with the CEO of a very large payer whose workers are no longer required to work in office. When I asked about work from home, this eminently reasonable individual was mildly surprised, saying something like “of course we support WFH…there’s no reason for most of our folks to go to an office…they did just fine during COVID and like WFH so why change?” This person noted real estate and related costs would be reduced as would other expenses associated with an office-based work environment.
2. A conversation with the estimable Bill Zachry, a person I am fortunate indeed to consider a good friend and mentor. Bill noted the challenges payers are experiencing finding and keeping adjusters.

It seems wildly obvious that WFH will help payers keep and find staff while lowering overall costs, significantly reducing ULAE (unallocated loss adjustment expense). Every payer C-suite has been on a cost-cutting rampage for several years in an effort to improve margins and adapt to declining frequency and shrinking rates.

In what can only be described as a logical fallacy, many payers are now “requiring” staff return to the office for more than an occasional day.

Good luck with that.

Most people do NOT have to work in an office, yet many CEOs refuse to accept that they – the Tyrannosaur Rexes of our time – cannot bend lesser beings to their will.

Sure, many workers are already back in the office, and some few prefer it. But most would much prefer not:

• having to deal with child care emergencies by taking PTO;
• commuting;
• dealing with office politics;
• wasting time at birthday parties, Monday morning “how was your weekend” chats, water cooler analyses of whatever sporting event, updates on officemates’ kids amazing (insert school/sports/music/theater/other), or the millions of other time wasters engrained in office-based work.

Shockingly, workers would much prefer to spend the 2 hours or so a day commuting with their family, or doing work, or exercising, or gardening or whatever.

And they’d rather save big bucks by ditching a car and its attendant insurance, license, tax, toll and maintenance costs; giving up the monthly commuting pass; not paying to park; having lunch at home and on and on.

To be sure there are arguments, some of them even reasonable, in favor of in-office work…yet the fact that most every organization survived COVID WFH is a rather compelling proof statement that WFH works.

What does this mean for you?

Mesozoic-era management will fail as will its proponents and the organizations they lead.

Last time we talked about weapons…how many each side had, what’s been lost, and the challenges in replacing those weapons.

Today’s newsfeed arrived with the VERY welcome news that Germany has OK’ed supplying Leopard 2 tanks, and we will be sending Abrams tanks to Ukraine. The UK had committed to send 14 of its Challenger II tanks to Ukraine… Note that countries that use Leopard 2s have to get permission from Germany before sending them to Ukraine; with this latest announcement sources indicate Ukraine will get at least 100 Leopard 2s.

This will supply roughly one brigade – and is about 1/3 of what Ukraines’ leaders say they need.

These are “main battle tanks” [MBTs], a term describing very heavy, very well armored vehicles with very powerful cannons. Unlike the other armored vehicles already sent to or on the way to Ukraine, MBTs are much more likely to survive an IED, land mine, rocket or artillery attack.

Highlights…

• Leopard 2 tanks are very capable; well armored and with a very powerful cannon, highly mobile, durable and simpler to maintain than the US Abrams tank
• there are thousands of them in more than 19 armies

  

• The US Abrams is equally if not more capable, BUT…
  • guzzles fuel (although it can use jet fuel, gasoline, or diesel)
  • requires a lot more maintenance
  • is really heavy and thus harder to transport

Timing

These will not be there tomorrow…however I’d bet NATO countries will be sending tanks from their current units rather than pulling mothballed older versions and going through what could be a long and difficult process of upgrading them and preparing them for battle.

Then there’s spare parts, fuel, ammunition, training, repair and maintenance  personnel and facilities and transport. These are massive, very complex vehicles that require a lot of care and feeding.

Experts contend that Ukraine’s Army has shown itself quite able to learn complicated weapons systems quickly; it’s use of the HIMARS rocket system, artillery, and anti-ship missiles has been pretty impressive.

What does this mean?

This is a major move, one that will definitely improve Ukraine’s chances of retaking territory. 

That said, like any tool, it comes down to how well it is used. 

Its that time again, when I throw caution (and good sense) to the wind, polish up the crystal ball and guess reveal what big things will happen in worker’s comp this year.

Off the diving board, and hope there’s water in the pool…

1.  The soft market continues…
   And it won’t harden in 2023. Medical costs remain very much under control (with  an exception), rates continue to drop, employment remains very strong (essential for return-to-work) and there’s lots of payers fighting for market share.
2. Medical spend is NOT a problem – and will NOT be in 2023.
   With a couple notable exceptions – to be covered in a future post – medical inflation will remain under control. In part this is driven by much lower drug spend and more specifically the continued decline in opioid spend. The latter has a big impact on claim closure and total medical spend.
3. Behavioral health and its various iterations will gain a lot of traction.
   More State Funds, carriers and TPAs will adopt BH programs, more patients will benefit, and more dollars will be spent. There’s a growing recognition that medical issues aren’t hindering “recovery” near as much as psycho-social ones. This is great/wonderful/long-needed and will really benefit patients and payers alike. Kudos to early adopters, and LETS GO to you laggards!
4. One Call will be sold. 
   I keep forecasting this…and one day I’ll be right.  It has to be this year. CEO Jay Krueger and colleagues have OCCM on a better track, but structural problems (i.e. declining claim volume) and internalization of One Call-type services by Sedgwick and others make the future…less than promising. Couple that with recent ratings actions by Moody’s and S&P and it’s time to do the deal.
5. New technology will make its impact felt.
   Wearables, chatbots (I HATE THEM), and Virtual Reality-driven care are three ways tech platforms/systems/things will significantly ramp up in ’23. Expect several large/mid-tier payers to adopt new tech in a major way – aka not just a small pilot.
   Structural issues with health care (try to find a LCSW or Psych-trained counselor), lack of trained adjusters, and frustration with rising rehab expenses are all contributors.  

Later this week – the other 5 predictions.

Today’s the latest in a three-part update on Russia’s war on Ukraine – we covered military manpower and the motivation to fight before the holidays, today we finish with (a very brief) discussion of losses and supplies of materiel and ammunition, and the overall supply (logistics) situation.

Weapons

According to Ukraine’s Ministry of Defense, Russia has lost over 2000 artillery systems, 4700 trucks and fuel tanks, 550 planes and helicopters, 3000 tanks and over 6000 armored trucks to date. I’m skeptical; opponents’ claims re the casualties and destroyed materiel and machines suffered by the other side are usually pretty – if not downright wildly – optimistic.

I’d suggest the UK’s figures are more accurate:

4,500 armored vehicles, 63 fixed-wing aircraft, 70 helicopters, 150 unmanned aerial vehicles (UAVs), 12 naval vessels, and over 600 artillery systems.

And yet another source which seems to have pretty specific data…and is summed up neatly in this piece.

The latest analysis shows that in the ongoing war in Ukraine, total Russian equipment losses reach 8,515 as of 21 December. In contrast, Ukraine’s military has lost 2,613 pieces of equipment in combat.

Russia had far more materiel at the outset, but is having a very difficult time replacing losses of their more modern equipment and vehicles.

From Army Technology – Ukraine has received:

the Patriot air defence missile system is on the way – this will help combat Russia’s assault on civilian infrastructure

US has provided or promised to provide more than 11,000 military platforms for the land, sea, and air domains (crewed and uncrewed) and more than 105 million small arms, mortar, and artillery munitions, among an undisclosed number of other high-end missiles.

Platforms provided include Mi-17 helicopters and T-72 tanks, and western equipment such as the High Mobility Artillery Rocket System, 155mm, 122mm, and 105mm artillery, and armoured mobility vehicles such as the M113, M1117, and Mine Resistant Protected Vehicles, also known as MRAPs.

While Russia is getting drones, some armored vehicles and tanks and ammunition from a few allies/suppliers, it doesn’t have near the supply chain enjoyed by Ukraine. The NATO equipment is more modern, more lethal, and harder to locate and destroy than much of the equipment Russia is now using as replacements for lost equipment.

US Javelin rocket – used against armored vehicles

HOWEVER, a rule of thumb is about a third of equipment is out of action at any one time due to maintenance, repair, upgrade, or training.

AND, there are reports that NATO and US supplies of some munitions and equipment are running low, and replacement/restocking will take time. A very detailed study is here.

Logistics

I wrote a pretty detailed post 10 months ago about logistics, which is simply getting enough supplies to the units that need them – when they need them. Simple enough in concept  – incredibly hard in practice, and while one could certainly think planning is everything, history suggests that pre-war plans are usually based on the wrong assumptions.

Here are key takeaways…

• Russia’s incredibly corrupt government has enriched a handful of oligarchs. These gazillionaires got huge contracts to supply tires, medical kits, rations, clothing, winter gear and spare parts; build military bases; fabricate tanks, airplanes, helicopters, rockets, ammunition, armored vehicles, airplanes, trucks and artillery; and spent most of those rubles on huge yachts, estates in Switzerland, supercars, Caribbean resorts, designer baubles and personal security staff. As a result, the military is short of pretty much everything, which is why…
• Russia is running out of ammunition.  Reports indicate it may need to use artillery shells that are years past their use-by dates. turning to Iran and North Korea for ammunition, drones, and other materiel.
  This from Military.com…
  • Degraded ammunition can injure or kill troops who fire it. “You load the ammunition and you cross your fingers and hope it’s going to fire, or when it lands that it’s going to explode,” the official said.

(a very good discussion of this is Martin van Creveld’s SUPPLYING WAR)

What does this mean?

Ukraine is winning. That does NOT mean it has – or will – win.

That depends on continued support from NATO and all of us. 

Last night, Ukraine President Volodymyr Zelenskyy spoke to both Houses of Congress, both parties, and all of us.  He spoke eloquently and passionately, describing the suffering of his people and their total commitment to defeating Russia and reclaiming all Ukrainian lands stolen by Putin.

What Zelenskyy knows – and I mean KNOWS – is the more Putin bombs Ukrainians, the stronger those Ukrainians become, and the more committed they are to seeing this through to Putin’s bitter end.

Net – Putin’s attack on civilian targets will strengthen Ukrainian resolve, not weaken it.

Here’s why.

I had long thought that the horrific bombing campaigns of World War II helped bring the war to a close by battering Germans and Japanese into submission. [full disclosure – my father was a machine gunner, bombardier, and armorer in the 8th Air Force in England during the second World War.]

Boy was I wrong.

Credible research indicates German production actually increased during the war; while it didn’t reach planned levels (which were likely overly optimistic) it did exceed pre-bombing campaign volumes. Research by the US Strategic Bombing Survey came to the opposite conclusion, however there’s a) big time confirmation bias and b) no evidence that the Survey captured civilian morale data.

Research conducted during Germany’s Blitz (aerial bombing) of UK cities concluded…

the Germans gained nothing from their investment in bombing British civilian targets as part of “The Blitz” (1940-41). Before “The Blitz”, they may not have been happy about having their air force destroyed by the Nazis, but they were also not eager to put their lives on the line to support a hereditary aristocracy that just over 20 years earlier had wasted a substantial portion of a generation of young men in a senseless war. However, as their homes were being destroy and their neighbors killed or wounded by German bombs, ordinary British men and women did not all rabidly support Churchill’s exhortation, “We shall never surrender“, but they continued to work, and they took action to ensure that essential services were provided when their official leaders failed to do so.

long as I get my cuppa tea, dearie…

TO be sure, this was NOT the whole story; there were many instances of looting, bigotry and finger-pointing, panic and social conflicts. That said, definitive research into civilian morale during the Blitz found the bombing produced:

a people who became actively committed to the project their leaders put before them, who cooperated with the drastic re-ordering of daily life that this entailed, and who, on the whole, did so in a spirit of stoical endurance that did not exclude good humour’. [emphasis added]

Further research on the impact of aerial bombing from 1917 to 1999 found:

(1) air power coercion attempts are more likely to work if they exploit military rather than civilian vulnerabilities, (2) the regime type of the target affects the chances of success, and (3) success is less likely if the attacker demands that the target change its leadership. Results show that coercion is more likely to work if the target’s military vulnerability is higher, but higher levels of civilian vulnerability have no effect on the chances of coercion success; that target regime type has no effect; and that success is less likely when the attacker demands the target change its leadership

In his book TRIBE, author Sebastian Junger details how people react to  having a common enemy, using examples from the Serb-Croat war’s effects on teenagers in Sarajevo and data on depression, anxiety, suicide among British citizens during the Blitz…the net is those issues declined rather significantly. Junger concludes that a common enemy draws people together, all working as one to defeat a single threat.

What does this mean for you?

Ukraine will win.

The more support we give them, the sooner this happens and the fewer Ukrainians will suffer and die.