Insight, analysis & opinion from Joe Paduda


The Pro-Life solution to the US health crisis

There’s a health crisis in the US – more people are dying younger, most from preventable diseases.

The good news is this is fixable. Sure there are any number of causes –

  • the opioid epidemic continues to destroy lives,
  • more kids are killed by firearms than anything else;
  • cancers associated with pollution are a major killer in some states;

all of which require thoughtful and very well-executed policy changes…which will take a lot of time, during which many more of us will die.

Like any complex problem the first task is to determine where the problem is. Thanks to the CDC, we know.

The lightest shaded states have the lowest life expectancy…

And the deepest red indicates states have the longest life expectancy.

8 of the States with the two lowest life expectancies have not expanded access to Medicaid…

And all of the States with the highest life expectancy HAVE expanded Medicaid.

Healthier people – kids, moms, grandparents, the disabled – live longer, more productive lives. And people with access to healthcare are far healthier than those without.

What does this mean for you?

If you are pro-life, the solution is blindingly obvious.



Good news, Friday!

Here it is, spring at last.

Well…not here in central New Hampshire where we’re going to get somewhere from 21″ of snow to…3-6″.  Gotta love the northeast in “spring”!

Income vs Inflation

Things continue to improve with worker income increases outpacing inflation.

From USAToday:

the average salary in the U.S. has grown by 5.4%, there was a gain of 3.2% in the Consumer Price Index for All Urban Consumers. This indicates that the average income increase is also an increase in people’s real income — taking into account their spending power.

Workers have seen steady increases in earnings over the last two years…

Two other items of note:

  • Black unemployment fell beneath 5 percent for the first time in history this last April.
  • There are 6 million more jobs today than in December 2019.


The CHIPS Act – bipartisan legislation that funded development of domestic computer chip research and manufacturing – is creating tens of thousands of new jobs, many in Ohio, Arizona and Nevada.

And that’s just the start.

Today, a total of zero computer chips are manufactured here…in less than 6 years, 20% of the world’s most advanced chips by 2030 will be made in the USA.

That is great news indeed for workers, families, national defense, and our position in the world as the leading innovator of next-gen technology.

Kudos to politicians on both sides of the aisle.  


One of the issues with healthcare research is studies, findings, and interpretation thereof may not factor in differences between male and female conditions, treatments, reactions to those conditions and treatments, long-term complications, and diseases and medical issues specific to either sex.

To address these disparities, The Administration announced a “new NIH-wide effort that will direct key investments of $200 million in Fiscal Year 2025 to fund new, interdisciplinary women’s health research…”

As more than half of Americans are female, this is very welcome news.

What does this mean for you?

We are getting wealthier and healthier.



Deconstructing Comp Pod!

Friends and colleagues Yvonne Guibert and Rafael Gonzalez went waaaay out on a limb and asked me to do another podcast.

I was all over the place, but Yvonne and Rafe were kind enough – and smart enough to rein me in when I diverged away from what was supposed to be the focus – impact of economics and the upcoming election on workers’ comp.

A deep dive into the economy started things off – how the House of Representatives affects physician reimbursement – and how that affects workers’ comp.

and how Medicaid dis-enrollment affects workers’ comp.

and how wage increases have outpaced inflation.

Listen on!



Checking in on Medicaid…41 states have expanded Medicaid, and by dribs and drabs some of the holdouts are moving to do the same.

Georgia may well be the next state to follow suit; a court recently ruled in favor of the Peach State’s approach.

Medicaid is one of those rare programs that delivers way more than it costs – economic impact is strongly positive, beneficiaries are much more likely to be healthy enough to work, clinical outcomes improve…

Oh, and uncompensated care costs drop – a LOT…so health systems and hospitals have less incentive to hoover dollars out of employers’ pockets.

Infrastructure investment – Billions of dollars will be invested to  improve infrastructure in places that need it most. From WaPo:

Earlier this week the White House unveiled $3.3 billion in federal grants to remove or retrofit highways that separate minority neighborhoods in many cities from jobs, entertainment centers, hospitals and other services.

In one of my adopted hometowns – Syracuse – the process is well underway. This rights a wrong done decades ago when politicians steamrolled poor folks in poor neighborhoods to build highways to suburbs.

Employment and long-term care

Yes, healthcare worker staffing is a big issue...the good news is much of the potential shortfall can be addressed by immigrants. 

Longterm care is particularly affected…three out of ten workers in long term care are adult immigrants.

What does this mean for you?

More opportunities, improved health, and more healthcare workers = a better place to live and work and raise a family.


Hackers disable nation’s largest healthcare data interchange

A major cyber attack has crippled the nation’s largest healthcare authorization and payment system, leading to weeks of missed payments.

From WaPo:

The hackers stole data about patients, encrypted company files and demanded money to unlock them. Change Healthcare subsequently shut down most of its network as it tried to recover.

The system owned by Change Healthcare, a subsidiary of United Healthcare, has been down since February 21; reports indicate BlackCat, a shadowy hacking group is responsible. BlackCat and/or a closely related entity reportedly received what appears to be a ransom payment of $22 million

UHC reported Change’s pharmacy processing functionality had been restored last week, and its

electronic payment platform would be reestablished beginning March 15, and that it expected to start testing and establishing claims network connectivity on March 18, with service restored through the week.

Don’t expect a full recovery then; that’s the date UHC will start testing a rebuilt system.

Change’s electronic communications, billing and payment system handles everything from utilization review to bill submission to validation to payment and reconciliation for hospitals, health systems, provider groups, clinics, specialty providers, pharmacies and Pharmacy Benefit Managers.

According to Change, the system handles about 15 billion transactions a year, or about half of all medical claims.

What does this mean for you?

P&C insurance execs and Boards should re-think  their chronic under-investment in all things IT.

note: HSA consulted for Change prior to its acquisition by UHG in 2022.


It’s a stutter.

I had a bad stutter for years,

From mid-seventh grade up thru high school I struggled mightily to get the words out, to avoid humiliation, laughter, scorn and – worst of all – pity.

As a formerly eloquent speaker and school play actor I had no idea what happened, why, how to fix it, and whether I’d ever be able to stand up in front of people and just…say   my   name.

It came and went for years after high school…I have a very painful recollection of  stuttering badly while giving a talk about exercise physiology during graduate school, watching the group suffer along with me.

Over the years I forced myself into situations again and again as I tried to overcome stuttering…for reasons unknown my stutter eventually faded into a distant if very painful memory.

I relate this because I am appalled by the media’s laziness, stupidity, crassness, and total lack of empathy all on full display when discussing President Biden’s occasional word stumbles. He’s not going thru dementia, nor does he have Alzheimer’s, and he’s not suffering the after-effects of a stroke.

Nope, he’s got a stutter.

Unlike me, the President has not fully conquered his stutter, yet he puts himself out there every day, knowing all too well he’s going to be laughed at, mocked, and demeaned because he stutters.

The meme-makers, mockers and insulters are pathetic indeed, seeking to drag down a person because of a sometimes-disabling condition, to use Biden’s condition to make them feel better about themselves, to get a cheap laugh from equally-pathetic barroom morons.

As for the media, I am furious with TV anchors, pundits, reporters, and editors for failing to address this consistently, fairly and completely. No, these superficial “personalities” would much rather parrot the “he’s old, see he can’t finish a sentence, mixes up his words, mumbles at times, and veers off track…” idiocy.

Well, you idiots masquerading as media those are ALL STRATEGIES STUTTERERS USE TO TRY TO GET THE WORDS OUT.

Mumbling hides stutters.

Mixing up words happens when you are desperately trying to find a word to use instead of the word that’s stuck in your throat.

Not finishing a sentence is because you can’t get the last words out without stuttering.

Going off track – same..

What does this mean for you?

How would you feel if you stuttered? Couldn’t communicate verbally? Got laughed at for something you can’t control?

I thought so.    So don’t be a jerk.



WCRI – the heat is on.

Kudos to WCRI – it is the first workers’ comp research organization to give center stage to the impact of climate change – primarily heat – on workers’ comp claims.

Dr David Bonauto of Washington’s Labor & Industry (state WC fund) led a session on Washington’s analysis of climate change’s affects on workers. A few quick takeaways…

There have been three studies re Heat Related Illness (HRI) in WA based on 16 years of data.  There were only about 850 accepted HRI claims out of 1.7 million…but the hidden impacts of heat are just beginning to be understood.

  • Heat increases absorption of chemicals thru the skin and potentially increases toxicity, a major concern for ag workers working with insecticides and fertilizers
  • Heat and wildfire smoke increases cardiovascular disease; it appears the mechanism is chronic inflammation.
  • Excessive heat leads to “incredibly diminished productivity”
  • There is a much higher [67%] risk of injury when temperatures are above 82-86 degrees compared to a baseline of 76 degrees.
  • The most vulnerable industry?   Public administration…my guess is this is driven by first responders and fire fighters.

thanks to MTI America’s Nikki Jackson for the slide pic

WA L&I isn’t the only organization doing credible research – WCRI research found 14% more claims occurred at times of high heat – think of these as indirectly related injuries. Falls off ladders are an example.  Great to see WCRI dig into this, although it would have been even better if we had this information several years ago.

The second employer session provided much-needed perspective from executives dating with the fallout from climate change.

Joann Moynihan from Travelers said the industry needs to broaden this dicsussion…it’s not heat claims specifically, but heat-related claims…Ms Moynihan’s words to the effect of “this is an indication of where the. industry is headed” should be a wake-up call to stakeholders who are mostly sleepwalking through massive changes to the work environment. 

Chrissy Lynch of the Massachusetts AFL/CIO described how workers in Mass are now dealing with forest fires…”we never thought we would”…that and it “doesn’t really snow here any more…we are trying to figure things out on the fly.

What does this mean for you.

Wake the *&^%** up. 


Good news Friday!…jobs and pay are both up!

275,000 new jobs last month – VERY good news indeed!

Since the beginning of 2021, over 10 million jobs have been created.

Yesterday’s jobs report showed strong employment growth across multiple industries;


Over the last 3+ years, 800,000 manufacturing jobs have been created..

Along with big job increases, wages are up too.

Last month average hourly earnings rose to $34.57 – a 4.3% increase YoY. (that’s about $69,000 a year)

From USAToday:

“Since the spring of last year, pay increases have outpaced inflation, giving consumers more purchasing power.”

What does this mean for you?

More jobs + higher wages = more payroll + more consumers buying more stuff.

Note – thanks very much to several folks at WCRI who thanked me for doing the Good News Friday posts – I appreciate you.

J.  – thanks for sharing that even though we may have different political views, you appreciate the posts.

Have a most excellent weekend!


To know why some think the US healthcare system is going to get better and cheaper – and why I strongly disagree, read on.

David Cutler PhD led off the WCRI’s confab with a discussion of the future of healthcare. It was GREAT that a conference has finally tried to educate work comp people about healthcare – after all that is the biggest driver of workers’ comp.  Sorely needed.

But…(more on that in a minute)

Dr Cutler noted that US healthcare is about as unstable as it has been for some time. And there is much more uncertainty to come.

He then asked the audience to vote on whether healthcare will get better and cheaper, stay the same, or collapse.

I voted collapse.

He also differentiated between “Trend” and “Wiggle”, noting it is important to consider what is actually a trend vs what is more likely slight ups and downs – need to differentiate between one-time factors and overall structural issues with long-lasting implications.

Cutler attributes consolidation among small providers to the drop off in patient service demand; that is, demand for providers’ services declined and therefore the smaller providers needed to merge or be acquired. I’d note that Cutler did not mention other factors driving consolidation, namely:

  • Interoperability (CMS IT requirements that can be a big lift)
  • small office staffing woes,
  • office operational expense increases, and
  • PE buyouts that make owners wealthy overnight.

Why Cutler is positive about the future of the US healthcare system

  • Delivery of medical care (number of services rendered) fell off during covid and really hasn’t fully recovered, which implies there are fewer unnecessary procedures/visits/treatments these days. (assumes the decline was mostly in unneeded services)
  • Elective stuff didn’t come back – such as hip replacements, shoulder surgery, etc.
  • Staff shortages are less of an issue of late

Dr Cutler also noted that in his view, medical staff burnout and labor force withdrawal from healthcare delivery roles will be temporary…Employment is coming back.

Very briefly, Dr Cutler’s thinking is that hospitals have too many beds; a lot of care has moved to outpatient facilities and ambulatory surgical centers (ASCs)…as a result hospitals will close floors, other hospitals will close, and the need for nurses in hospitals will thus decline.

Notably, Dr Cutler provided data from CMS to build a case that healthcare itself is better controlled – Medicare growth has been relatively flat over the last few years, and some analysts believe this has reduced total spend by several trillion dollars.

Finally, Dr Cutler also discussed value-based care and the move to bundled care, I suppose as evidence that healthcare is getting more efficient.

So here’s the “But…” in which I respectfully disagreed – and and still do disagree – with Cutler’s optimistic outlook.

Cutler – Shift of care away from and hospital closures will reduce costs and staffing needs

MCM – I don’t have the data, and I’m sure Dr Cutler does, but there’s both anecdotal “evidence” (family members have left patient care for other jobs in healthcare) and actual research that clinical staff shortages are NOT moderating.

Here’s rather compelling evidence that the shortage is NOT going away.

According to the United States Registered Nurse Workforce Report Card and Shortage Forecast published in the September/October 2019 issue of the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country through 2030. In this state-by-state analysis, the authors forecast a significant RN shortage in 30 states with the most intense shortage in the Western region of the U.S.

Perhaps Dr Cutler is talking over the very long term – and perhaps the Journal’s authors are not accounting for the shift in care to outpatient facilities.

Perhaps. On the other hand, change is very, very slow in healthcare.

Also, hospitals are major assets, assets which are providing a ton of revenue to the health system or hospital’s owners. Sure, many owners might like to walk away…but they can’t – not without huge pressure from unions, workers, communities and politicians. So, they’ll do anything they can to keep the patients coming, to keep the hospital open – if they don’t they will go belly up – oh and some of the hospital’s execs will not have jobs.

Cutler – Value-based care is saving money…

MCM – There is very little evidence that VBC actually saves money, and a lot of evidence that it doesn’t. In fact, a CBO study indicates that overall, well-funded, well-designed and well-run VBC initiatives actually resulted in higher costs. I’d note that some disagree with CBO’s results. – however those disagreements generally focus around better outcomes, health indicators and the like – NOT on cost reductions.

Cutler – Medicare spending is below predictions thus healthcare is less costly

MCM – But other payer spend has not.

Yes, Medicare’s costs have been below predictions…but that’s NOT the case for individual insurance, group health and Medicaid spend – which has has increased.

To be fair, Cutler agreed with my comment (which I made after his talk), but noted Medicaid spend per enrollee has declined.

He is correct…however in my view but likely because the expansion of Medicaid involved more healthier people being signed up before and during the COVID emergency.  And, their costs prior to enrollment were likely uncompensated care…so my take is overall medical costs weren’t reduced, just shifted to a different payer.

At least for the next few years – and likely longer – the “shiftee”, dear reader, is often workers’ comp.

Finally, good friend and colleague Gary Anderberg PhD of Gallagher Bassett commented that all of us are getting older and sicker and how does that factor into predictions re cost. Cutler indicated he sees it as a mixed picture as cognitive and CV health are improving while others – obesity-related such as diabetes in particular – are declining.

What does this mean for you?

I still vote collapse.



WCRI – Employers weigh in…

Good decision to add three very different employers to the conference; Publix, Disney and Duke University.

[As a Syracuse alum, I thought WCRI could’ve made a better choice than Duke…]

Here’s my quick take…there was a ton of content with which your faithful reporter could not keep up…so apologies for the somewhat disjointed post.

None of the three are doing pre-employment drug testing (except as required by law)

Publix self-administers work compMichele Maffei has over a hundred employees managing the program. Michelle and her colleagues are very involved in the entire process, work diligently to engage with local operations, and focus tightly on return to work. They handle clinical management, claims, and bill review inhouse. RTW is a huge priority; they try to get everyone – even amputees – back to a job at Publix; during Covid a transitional job was checking in folks showing up for vaccination.

Publix identifies the medical providers they want to provide care to their associates and in some cases contracts directly with those providers; “we are very purposeful about what we do.” Oh, and consistent with earlier findings, telemedicine usage has dropped off post-Covid.

Sharon DelGuercio noted Disney can pay above fee schedule if they need to get specific specialties in central Florida to treat associates. Still it can be difficult to ensure ready access. Disney focuses on the full scope of recovery drivers, striving to keep them in their home location, a strong transitional program with over 400 job descriptions.  Disney’s focus is, quoting Sharon; “nobody goes home”

Duke University’s Charles Kyle weighed in on behavioral health, a main focus of the worker’s recovery program. Return to work is also key; as Duke is very de-centralized different units have their own priorities however costs are tracked back to those units.

A recent focus and rising concern among healthcare professionals [Duke has a major medical center as well] is violence, especially gun violence.  Other forms of physical violence seem to have increased as well across both the medical facilities and University operations. Duke has a task force assigned to this and is steadily improving prevention and recovery initiatives for workers injured by violence.

Panelists acknowledged that in general there’s a higher level of violence, a higher level of incivility, they are just meaner than they used to be.

Michele mentioned physician dispensing (PDD) as a key priority; with their operations in Florida this is NOT a surprise.  MDs should not be allowed to give patients drugs as they are not pharmacists.






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