Charles Barber
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 Managed-care plans along with employers have been reluctant to pay the cost of ongoing psychotherapy," said physician-author Timothy B. McCall in his commentary on National Public Radio's Marketplace. "Even patients with serious disorders that stem from such things as childhood sexual abuse are being limited to just a few visits. That's if they are being seen by a therapist at all . . . The only area of mental health coverage that employers and HMOs seem interested in funding is drug therapy. |
Peter J. Whitehouse and Daniel George
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 As the proportion of younger workers continues to decline, it will become critical for employers who seek to retain a competitive edge in the marketplace to retain and attract older workers. There are strategies employers can use to do so. As the first boomers begin to head into their sixties, some companies are making sure they hang onto their workers by offering flex time, extra benefits, and paid family leave so that employees can handle their personal issues, including taking care of aging parents of their own. |
Shannon Brownlee
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 Most workers had health insurance through their employers by the 1960s, largely as a result of collective bargaining by unions, but there were two groups of Americans who were still "going bare": children and the elderly. Two thirds of the more than thirteen million Americans who were over age sixty-five had incomes of less than one thousand dollars a year—a third less than the rest of the population—yet their medical needs were roughly three times higher. |
| With this form of insurance, also known as an indemnity plan, employers paid most of the premium, and the
L~Z L T Ll\ I Ilk. ft I L U insurer reimbursed patients for 80 percent of the doctor's fee—for practically anything the doctor ordered. There seemed to be no limit to what insurers would pay. By 1980, there were nearly 400,000 physicians in practice, or about 163 doctors per 100,000 in the population.That was up from 260,000 physicians in 196c, the legacy of medical school expansion that had been underwritten by the federal government in the '60s to reverse a perceived doctor shortage. |
| Fee-for-service plans were an important part of the benefits package companies used to retain workers, but with the economy sagging and the price of health insurance premiums rising at double-digit rates, employers began putting pressure on insurers to get a grip on costs. Insurers had long known that the only health plans whose costs weren't going through the roof were the traditional health maintenance organizations, the true HMOs like Kaiser Permanente, in California and much of the West, and Group Health Cooperative of Puget Sound, in Seattle. |
| A little more than a decade later, with stagflation in full bloom and employers clamoring for relief from mounting health care costs, private insurers felt emboldened to exert some measure of control over physicians and hospitals. The old fee-for-service way, they said, rewarded greedy doctors, who padded their incomes by giving patients unneeded tests and procedures and putting them in the hospital unnecessarily. Their version of HMOs, dubbed managed care, would impose discipline on medical providers. |
Michael J. Panzner
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 The dynamic between employers and employees will undoubtedly skew in favor of the former as conditions deteriorate, with corporate survival turned into a blunt instrument to repel demands for better working conditions or higher compensation. Under such circumstances, loyalty will count for very little, and any sense of moral obligation to the longer-term welfare of workers will continue to erode.
Firms that are already in trouble or that depend on industries considered vulnerable will need to be monitored closely, especially if they represent a primary source of household income. |
Shannon Brownlee
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| Double booked
In the early days of the managed care revolution, patients didn't notice much difference between the old fee-for-service and the new way, except for the price. Most employers offered a choice between traditional fee-for-service; one of the new, so-called HMOs; and a PPO, or preferred provider organization, doctors who had agreed to work for lower fees. The employee's share of the premium was lower for HMOs and PPOs than for fee-for-service, and so were his out-of-pocket expenses. |
Craig Pepin-Donat
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 The constant pressure of employers to cut costs to improve their bottom line has many companies reducing benefits to employees, and for small businesses; it is almost impossible to provide decent employee benefits. According to a 2006 Kaiser Family Foundation study, the average American family pays $11,500 a year in health insurance. Across the country, healthcare insurance rates are going up 10 to 30 percent a year, far outstripping wage increases. It's outrageous. We are all paying more and getting less.
However, there is a model that works. |
Paul D. Blanc, M.D.
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 Conditions improved over the last century because safety was profitable: employers wanted to avoid injuries that lessened productivity and drove up cosrs, notably the bill for workers' compensation insurance.23
In his commentary, Tierney reveals his own personal bout of work-related tendonitis brought on by heavy typing, an injury that put him "out of commission" for six months. |
| One intervention popular among some employers was to provide the laborers in their factories with turpentine-soaked sponges to wear beneath the chin as a protector against the phosphorous fumes. This was about as effective as the governmental hygiene rules, whose failure was clear from the beginning. In 1863, a British physician named Henry Letheby, who had cared for many patients suffering from phossy jaw, testified to an official commission. |
Michael J. Panzner
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| Companies in serious financial straits—not to mention stakeholders, including the local communities that lose big when area employers fail—will find the negotiating landscape unaccommodating. Before securitized markets and the era of aggressive financial operators who focused on maximizing gains, a lender or an investor might have had an interest in helping a troubled business survive and thrive—but no more. Instead, Main Street will be roiling with mass layoffs, abrupt shutdowns of plants and divisions, and facilities left idle and unkempt while bankruptcy courts decide their fate. |
| Massachusetts, meanwhile, planned to introduce statewide health insurance funded by a mandatory fee on employers and individuals.
But in the end, such measures won't bridge the gap. They will merely shift a portion of the burden to a different spot, like the air in a squeezed balloon. As the pressures from an unwinding debt bubble, a falling housing market, and a collapsing economy continue to grow, the retirement system and other wobbly towers of promises-to-be-broken will soon come tumbling down. i C h a p t e r
GOVERNMENT GUARANTEES
"The only sure thing about luck is that it will change. |
| Other obligations that were once an integral part of the compact between employers and employees will be readily cast aside. That move will be easy enough to justify when corporate survival options are limited.
In a rapidly burgeoning job seeker's market, older Americans will be joined by legions of formerly nonworking spouses and teenage children who will have been pressured to seek out extra sources of income to help their families make ends meet. |
| Virtually all of these intelligence-gathering methods will also prove useful for keeping tabs on employers, partners, vendors, landlords, customers, and any other parties that could affect one's financial future if the relationship turned sour. Certain relationships, like those with doctors, caregivers, teachers, and contractors, will be about more than just money. Extra precautions, such as checking with licensing or other authorities, whether or not the data are available online, should be taken as a matter of course. |
Shannon Brownlee
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| The new way meant parents found his name in "the book," the directory of in-network providers they got from their employers. From their perspective, he was no better or worse than the next guy on the list.
Pretty soon, Peabody and his partners noticed something else: more and more paperwork. Managed care companies began sending them notices, instructing them on how to manage their office and care for their patients. They were told to put a sticky note on the records of patients who needed to be tested for allergies. |
Andreas Moritz
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 Although flu vaccines can never be accurate, employers encourage millions of their employees submit to a flu shot each year, trying to avoid the loss of working days.
Influenza always starts in the Far East, and then spreads to the West in early winter, reaching its peak during February and March. It may come in either of three types, A, B, or C. During the last several years, type A has been the dominant version. What makes vaccination against the flu so unsuccessful is that the strains of the flu virus are different every year and the so-called protection lasts for only six months. |
Caldwell B. Esselstyn, Jr., M.D.
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 For instance, we can approach insurance companies, employers, and representatives of labor with a modest proposition: that heart patients targeted for the mechanical intervention of bypass surgery or stenting should first try twelve weeks of arrest-and-reverse therapy—plant-based nutrition plus, where necessary, cholesterol-reducing drug therapy. |
| Across the American economic spectrum, employers are trying desperately to rein in health costs, asking workers to pick up more of the tab for their care or, in many cases, dropping insurance coverage entirely. Labor unions are discovering that they cannot negotiate contracts that keep wages apace with inflation because the cost of health care is severely eroding corporate profit margins. Companies are closing down factories and jobs at home and relocating them overseas, where wages and health costs are much lower. |
Dr. Edward F. Group III, DC, ND, DACBN
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| However, no amount of vacation time is legally mandated in the United States, so vacation is just an arbitrary period left entirely up to the individual employers! No wonder we're having so many stress-related problems— there's no time for our bodies to regenerate! Basically, physical stress leads to psychological or emotional stress which further compounds the strain on the body and organs such as the colon.
Did You Know A Misaligned Spine Can Cause Colon Dysfunction?
A less obvious physical stressor is a misaligned spine. |
Devra Davis
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 Generally speaking, however, employers are no more responsible for the lack of information about industrial cancer than are the many thousands of physicians who have cancer patients in industrial areas or who actually are associated with factories. It is an unquestionable fact that an appreciable number of occupational cancers slip through the hands of doctors unidentified. This is due in a great degree to a general ignorance of the occupational aspects of cancer. |
| Lawsuits brought on behalf of those who believe their injuries were caused by their employers' bad actions succeed less and less often. In large part this is because recent court decisions have changed the rules of the game and the presumptions of evidence.
It may shock you to learn that of the 100,000 chemicals that are commonly used in commerce, most have not been studied as to their ability to affect our health. |
Charles Barber
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| The only area of mental health coverage that employers and HMOs seem interested in funding is drug therapy. They'd rather just throw Prozac, or better yet, some generic substitute costing pennies a pill, at mental health problems."16 The strong likelihood is that the nightly fluttering of the two or three pills down her throat will be the extent of Julie's "mental health treatment. |
Bottom Line Health
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| We're looking at the tip of what's happened with the erosion of benefits, as employers and plans start to share the costs with employees. We're going to see more of this," Doty predicts.
RECENT STATISTICS
In 2003, one in five working-age Americans who had chronic health problems—approximately 12.3 million people—lived in families that had problems paying medical bills, according to an analysis by the Washington, DC-based Center for Studying Health System Change (HSC).
For some families, filing for personal bankruptcy may be the only way to escape the debt they've piled up. |
Mike Adams, the Health Ranger
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 Addicted to profit
So if nurses, doctors, employers, state governments and nearly all the people in the country want universal health care, why hasn't it happened yet? The answer is simple: Because the corporations currently profiting from sickness and disease don't want to give up their control over health care. Big Pharma is making billions of dollars selling dangerous drugs to people who largely don't need them. Health insurance companies are raking in billions more by denying payment for medical procedures. |
Mike Adams, the Health Ranger
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 Just about everybody's either financially strained or going broke due to spiraling health care costs: the people, the employers, state governments and even the federal government. Multinational corporations are fleeing the United States due to health care costs, taking jobs and economic productivity with them. Meanwhile, 50 percent of personal bankruptcies in the U.S. are due to medical expenses.
But not everybody's doing badly. |
Mike Adams, the Health Ranger
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 We're already bankrupt, actually, but we're just making it even worse with these sky-high health care costs.
Our employers are going bankrupt trying to fund the health insurance of their employees. It makes U.S. workers unable to compete in the global marketplace. This is one of the reasons jobs are increasingly shifting overseas. It's because U.S. workers are just too expensive to insure due to our health care system (if you can call it that). I say you can't solve this problem by subsidizing insurance or by forcing employers to cover everybody. |
John J. Ratey, MD
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 He could also shift the flow from fear to action circuits by making a list of potential employers to call—a more classic example of active coping—but it wouldn't affect the brain as broadly. By doing something other than sitting and worrying, we reroute our thought process around the passive-response center and dilute the fear, while at the same time optimizing the brain to learn a new scenario. Everyone's initial instinct in the face of anxiety is to avoid the situation, like a rat that freezes in its cage. |
| And the town's major employers are science-centric companies such as Argonne, Fermilab, and Lucent Technologies, which suggests that the parents of many Naperville kids are highly educated. The deck—in terms of both environment and genetics—is stacked in Naperville's favor.
On the other hand, when we look at Naperville, two factors really stand out: its unusual brand of physical education and its test scores. The correlation is simply too intriguing to dismiss, and I couldn't resist visiting Naperville to see for myself what was happening there. |
Gerald E. Markle and Frances B. McCrea
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 Such imposition might be promulgated by employers refusing to hire smokers or drinkers, or by health care providers refusing to insure such people.25 We understand the impulse. Yet we fear that the proposed cure might be more dangerous than the disease, for to implement such a policy might seriously compromise our rights of privacy, which Fran and I, along with many others, hold quite dear.
Even more, the emphasis on personal responsibility misses the point almost completely. As I wrote some time ago, the decision to begin smoking is one embedded in cultural practices. |
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