California Road Trip, Day 16, Still in Los Angeles

Our thoughts are mounting!

Our sick care non-system is far more broken and corrupt than you can even imagine.

We spent the evening with a dear old (like me) medical school friend Dr. Paul Papanek.  After the usual “catching up” and retelling of old stories, our talk turned to, of all things, health care.  As an Occupational Medicine physician, without equivocation he railed that for every dollar paid into the workers’ compensation system, only twenty cents goes to actual care!  Evidently workers compensation is a very lucrative niche for all involved, including carriers, independent medical examiners, and lawyers who seem to have a hand in everybody’s pocket.

He cited a 2008 study of 4,387 of low-wage industries in the three largest U.S. Cities.  Aside from finding rampant violations of minimum wage protections, overtime reimbursement, and food-break laws, of those workers “who experienced serious injury on the job, only 8 percent filed a workers’ compensation claim.”  Furthermore, “When workers told their employer about the injury, 50 percent experienced an illegal employer reaction—including firing the worker, calling immigration authorities, or instructing the worker not to file for workers’ compensation.”  And, “About half of workers injured on the job had to pay their bills out-of-pocket (33 percent) or use their health insurance to cover the expenses (22 percent). Workers’ compensation insurance paid medical expenses for only 6 percent of the injured workers in our sample.”  They concluded, “the workers’ compensation system is not functioning for workers in the low-wage labor market.”    Paul agrees then goes on to say that even those higher paid workers who do get into the system find it badly broken.  It is fraught with perverse incentives and, too often, economic entities profit when a worker doesn’t  return to work.  It’s insane.

Paul’s lovely, lady friend, Tracy is a nurse practitioner with her own story, which she has seen repeatedly.  After an expensive hospitalization, a stroke patient, is discharged with a two month’s supply of medications… intended to decrease the chances of another stroke.  Of course, he can’t afford to pay for them and there’s no systematic mechanism to supply it longer.  Many months later, he arrives in the ER with another stroke and another expensive hospitalization for which we all pay.  Sheesh.

Every week or two, I learn something more about our “system” that suggests it is even more broken and corrupt than I could possibly imagine two weeks ago.  And I keep being surprised by this?

–paul hochfeld

One Response

  1. Paul Papanek

    Pablo – It was WONDERFUL visiting with you!

    To your readers – I should tell you that back when Hochfeld and I went to Med School together, it always seemed that he saw and felt things more deeply than the average chap. My own medical career as both a Family Physician and Occupational Medicine physician has also persuaded me that our current Sick-Care Non-System is broken in ways we can barely imagine.

    In my own practice, I take care of plenty of workers’ comp patients, and see the absurd contradictions in incentives and barriers to care many times each day. Even more troubling, as Paul mentions in his posting, is that the current system completely fails low wage workers. When it comes to labor injustice, when it rains it pours.

    What’s good for Group Health (Single Payer) would also be very good for Occupational Medicine. So, we’ll add this to the list of things that need fixing.

    Lots of hugs to Hochfeld and his intrepid band of stalwarts. / Paul Papanek MD, Los Angeles, California