Today we welcome a guest post from Nortin M. Hadler, M.D., and Stephen P. Carter, J.D., authors of a new open-access pamphlet published by UNC Press, Promoting Worker Health:  A New Approach to Employee Benefits in the Twenty-First Century.

In this extended essay, the authors introduce a new approach to reforming the American health-care system–a plan they call the Universal Workers’ Compensation Model (UWCM). Drawing on Hadler’s expertise as a physician and Carter’s as an attorney, the two have conceived the UWCM as a state-level alternative that would supersede current solutions debated at the national level. At the heart of the UWCM is a broader understanding of what constitutes worker’s health, one grounded in scientific research and cognizant of the wide range of physical and mental illnesses that can afflict workers. The UWCM stipulates a single policy providing rational and reasoned recourse for universal risks: illness, injury, disability, and death.

Presenting their ideas with precision in this 34-page pamphlet, Hadler and Carter intend to spark discussion among health-care providers, insurers, legislators, and everyday citizens about how we might move beyond the limits of the current debate toward new, truly effective solutions.

The full pdf of the pamphlet is available for viewing and downloading on the bookpage.

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Redesigning the American Health Care System

Overtreated, overpriced, over-regulated, and over-legislated: that’s for starters. How about over-screened, over-diagnosed, over-medicalized, over-staffed, over-digitized, and over-litigated? Then there’s unavailable, inaccessible, non-empathic, and even cruel when it comes to the disabled, disallowed, the disaffected and the disavowed. To top it off there’s the American fashion of dying, alone and encumbered by the machinery of futility.

Political pundits and policy wonks point fingers at the mainstream American health care system, sometime more than one finger, often at more than one putative culprit. It’s open season.

The American people and their elected representatives are left on the side-lines to ponder the resulting noise. In addition to the finger pointing, Americans are buffeted by anecdotes from their neighbors; some are true believers and others sling reproach consequent to negative experiences. The national cognitive dissonance is further inflamed by all sorts of agencies bearing gifts and promises or castigating others. No day can dawn without the mustering of campaigns in direct to consumer marketing and the marshalling of pronouncements from all the Elmer Gantrys and sages employed by the media.

How can this be in an era when health and disease have emerged from the miasma of presupposition into scientific enlightenment? We apply finely honed critical razors to every aspect of health care from its administration to clinical interventions. We assume we hold the welfare of the patient as inviolate. Is that cognitive distortion, a national self-deception? Are we fooled, yet again?

Attempts to reform the American “healthcare” system leave a legacy of disappointments and unintended consequences. The Affordable Care Act (ACA) is a stark testimony to that legacy.  It was ushered in with the promise of better healthcare at a better price and has not delivered on either count. Today it is a whipping boy in the halls of our Congress. Everyone agrees that something must be done because the system is unsustainable. All are participants, knowingly or otherwise, in the medicalization of society.  But no participant wants to assume responsibility for calling a halt to finger pointing and the “blame game.”  Reforming the American healthcare system has proved Sisyphean, if not counterproductive.

Rather than pursuing reform, we bring perspectives from medicine, law, epidemiology and risk management to craft a new alternative. We call it the Universal Workers’ Compensation Model (UWCM). The UWCM is an innovative approach to providing healthcare for one large segment of the population, the American worker. Our newly published pamphlet, “Promoting Worker Health: A New Approach to Employee Benefits in the Twenty-First Century,” introduces this concept more fully. We hope it will bring the UWCM into the public conscience and inject badly needed fresh thinking for the health policy debate Today, employee benefits in America are a highly variable package of insurance policies designed to mollify the consequences of many untoward events for which workers are at risk. Each of the categories of indemnity are served by separate businesses and regulatory schemes. Most are “defined benefit” policies; the worker pays whatever the employer doesn’t for coverage the insurer defines. By contrast, the UWCM stipulates a single policy providing rational and reasoned recourse for universal risks: illness, injury, disability, death.  Administration is fiduciary; money not expended is returned to the workers to be used to purchase supplementary health insurance as needed–for example, policies for non-working family members. And the profitability of the insurance company would be constrained by law.

The cost-effectiveness of the UWCM reflects its fiduciary nature (it is the employees’ money that is to be saved), the elimination of redundant overhead, the constraints on profitability, and the coverage itself which is designed with the employee as the sole beneficiary. The UWCM is not a variation on current themes. This is a totally novel alternative. And the system is voluntary. The enabling legislation, the UWC Act, would simply permit an insurance company to offer a new insurance policy that is defined and constrained by stipulations in the UWCA.  No insurance company has to offer this policy and no employer must purchase the policy.

We believe the UWCM will monetize altruism. We hope a wide range of readers will consider our proposal and join the debate.

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Nortin M. Hadler, M.D., is professor emeritus of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill and attending rheumatologist at UNC Hospitals. He is author of several books, including Stabbed in the Back: Confronting Back Pain in an Overtreated Society and Rethinking Aging: Growing Old and Living Well in an Overtreated Society. Stephen P. Carter, J.D. is an attorney in Arkansas.