...Out-of-control health care costs
(From Page 5)
that move.
At least 17 state governments are of-
fering some combination of incentives
and penalties to get employees to com-
plete a health assessment and take steps
to improve health. The State of Oregon
began such a program for its roughly
50,000 employees and spouses, domes-
tic partners, and dependents, based on a
model pioneered by American Federa-
tion of State County and Municipal
Employees (AFSCME) in Illinois.
Since January, the state has deducted
$17.50 a month for the roughly 14 per-
cent of full-time employees who fail to
complete an online health evaluation
and follow it up with two online health
classes. Next year, after agitation by
Oregon AFSCME and SEIU Local 503,
the two largest state employee unions,
the stick will shift to a carrot instead —
employees will receive $17.50 a month
when they do participate.
Oregon’s Public Employees Benefit
Board is also getting rid of the one con-
troversial piece of its Health Engage-
ment Model (HEM): asking members
to report their waist circumference. Pre-
viously, men who reported over 40 inch
waist circumference in the online HEM
health questionnaire, and women over
35 inches, were directed to join a
weight management program. The two
SEPTEMBER 7, 2012
union representatives on PEBB argued
that the stand-alone waist measurement
was not a fair assessment. Now the as-
sessment will only ask employees if
they are overweight.
UNITE HERE Local 54, which rep-
resents casino workers in Atlantic City,
New Jersey, combines the clinic and be-
havior change approaches. In 2007, the
union health trust teamed up with a lo-
cal hospital to set up a health clinic that
got startling results by focusing exclu-
sively on the sickest 1,200 employees.
Nationally, it’s estimated that 5 percent
of the population accounts for half of
health care spending. The Atlantic City
clinic offered greater personal attention
and “health coaches” to the sickest 10
percent — at no cost to patients — and
saw hospitalization drop by 41 percent,
emergency room visits drop by 48 per-
cent, and total spending drop by 12 to
15 percent.
Key to the success of the Atlantic
City effort, says Dr. Rushika Fernan-
dopulle, who was hired to set it up, is
that doctors are paid a flat amount per
patient, and clinic staff were able to de-
velop personal relationships with pa-
tients.
“The sickest people do the poorest in
the current system, and they’re the ones
who drive the costs,” Fernandopulle
said. “They have diabetes, hyperten-
Why is American health care so expensive?
Why is American health care so expensive? Part of the answer is that Amer-
icans are getting older, fatter, and sicker — especially with chronic conditions
like diabetes and heart disease that are linked to unhealthy diet and a lack of ex-
ercise. But it’s also because America’s “medical-industrial complex” is gripped
by the profit motive, even in nominal non-profits. When doctors are reimbursed
per visit and per procedure, they have an incentive to recommend more visits
and procedures. Meanwhile, medical science is funded to focus on treatments
with profit potential, and pharmaceutical and medical technology firms spend
fortunes marketing patent-protected discoveries to doctors and patients. Adding
to the cost, the current system of health insurance is fantastically complicated
and inefficient. Doctors and hospitals pay one set of administrators to bill in-
surance companies, and insurance companies pay another set to pay (or deny)
the claims — all of which consumes up to 15 percent of the health care dollar
while doing nothing for health.
sion, heart failure, they’re on many
medicines, seeing lots of docs, and
they’re in and out of the hospital and
emergency rooms. Those kinds of peo-
ple really don’t do well in the current
system, because it’s fragmented and re-
active.”
Instead of a typical practice, where
doctors get paid for each “sick visit,” the
Atlantic City clinic gets a flat fee from
the union trust, which allows it to be
creative in how it serves patients, Fer-
nandopulle said: “Many of the things
we think are of high value — a phone
call with patient, a group visit, doing a
home visit, having a ‘health push’ talk
with someone — none of that gets paid
for in the typical system, so they don’t
happen.”
Now Fernandopulle is working with
unions to set up other similar clinics: A
UNITE HERE local in Las Vegas
NORTHWEST LABOR PRESS
opened one six months ago, and a Car-
penters regional council is opening one
in Boston this winter.
In Portland, City Commissioner-
elect Steve Novick is interested in try-
ing Fernandopulle’s approach with City
employees, and partnering with other
large employers, like TriMet, that have
high health insurance costs.
“When you look at what’s happened
to the working class over the past 45
years,” Novick says, “the richest 1 per-
cent used to get 10 percent of the [na-
tion’s] income, and now they get 20
percent, and health care used to get 8
percent of gross national product and
now it gets 17 percent. The two things
have been eating at their paychecks to
an almost equal extent. So just as we
need to fight increasing inequality, we
need to fight increasing health care
costs.”
Guide Dogs golf
tourney Sept. 10
The 24th annual Machinists District
W24 Guide Dogs of America Golf
Tournament is slated for Monday, Sept.
10, at Heron Lakes Golf Club in Port-
land. A shotgun start is at 8:30 a.m.
Corporate and union sponsorships
are available starting at $250 and top-
ping out at $1,000. Entry to the golf
tournament is $125 per golfer.
All proceeds benefit Guide Dogs of
America.
For more information, contact Dan
Sass at 503-238-5550, John Hall at 503-
449-0969, Stacy Breunig at 503-702-
9879, or go online at www. iamw24.org.
Labor Roundtable
of SW Washington
banquet Sept. 28
VANCOUVER — The Labor
Roundtable of Southwest Washington
will host its annual Labor Awards Ban-
quet Friday, Sept. 28, at the Vancouver
Hilton, 301 West 6th Street Vancouver,
Washington.
A no-host bar will be provided start-
ing at 5 p.m., with dinner at 6 p.m.
The annual event recognizes labor
unions, labor organizations, labor lead-
ers, and union allies for their outstand-
ing service not only to the labor move-
ment, but to the community as well.
Tickets are $60 per person or $480
for a table of eight.
The Roundtable also suggests each
person donate an item for a door prize.
For more information, or to order
tickets, call 360-921-2864 or e-mail
eboctran@comcast.net.
PAGE 9