Volunteering for Trouble

The Compliance Traps, Administrative Nightmares, Subtle Discrediting & Employee Frustration Voluntary Benefits Often Bring

Special guest column by Dagny Taggart | March 2023

As a wee lass, my grandmother used to admonish, “don’t go borrowing trouble.”

I only fully internalized or “grokked,” as the kids say, that message once installing voluntary benefit plans.

In the eyes of the ginormous corporations that have devoured nearly all the insurance brokerage market, I’m reasonably sure this makes me a bad broker. Because, you see, once you are publicly traded, your stock prices and your national VP’s job are tied inextricably to the holy grail of growth.  Client retention is nice and may even earn you a pat on the head or some other form of little doggie treat, but growth, my lass, well, that shall set ye free! 

I’ll never forget a conversation with a notoriously unscrupulous brokerage owner in the San Francisco Bay Area. We were at some stuffy, pompous, self-congratulatory industry meeting where brokers take a temporary leave from the golf course to discuss how to best grow revenue (your premium).

The greasy, slick-haired, dark pinstripe-suited, mafioso-looking founder told our CEO, “I’ll never understand why you put so much stock in retention. Once a client has identified that you cannot service them as promised, it will still take them nine to eighteen months to leave for a new broker. You can sell a handful more groups in that time!”

Even though that was nearly 25 years ago, very early in my career, I always remembered the message.

And I hated it increasingly each year I practiced. 

As a brokerage office is purchased by a bank, merged with another bank, and repacked to a private equity firm like every other financialized product in our country, brokers are inevitably hounded with the mantra of growth. New sales conquest lists are circulated monthly, sometimes weekly, to prod already organically competitive salespeople to climb over each other to push more premium dollars through their P&Ls. One company I worked with even created a gameshow-like point system to maximize salesy behavior. Referrals to decision-makers, cold calls made, meetings attended, and spam sent all earned various forms of atta-boys from the official brass. Meanwhile, 20-plus-year veterans who consistently renewed multi-million-dollar books of stable clients were regarded as an annoying relic to a bygone era in American Business: a time when steady service, professionalism, and integrity hindered the mantra of G-R-O-W-T-H.

 Enter Voluntary Benefits

Voluntary benefits offer a quick fix for a stagnant book of steady, satisfied clients. It is the cocaine bump from the countertop in the club bathroom when a partier doesn’t have the energy or personality to peacock with the amplified type-As. With voluntary benefits, an employer can roll out additional life, disability, accident, cancer, critical illness, pet, home, auto, gap, dental, vision, or hospital insurance at no cost to the employer and only for those employees who want to purchase it. As the pitch goes, it rounds out your offering, maximizes choice, and gives people more opportunity to cover what is important to them. Who could be against that?

And I must admit, as a budding, libertarian-minded little brokerita, I bought into the concept. Voluntary benefits were, after all, voluntary and offered commission to the brokerage of an additional 15 percent to 55 percent, depending on the line of insurance offered. Employees win, the employer wins, and the broker wins!

Alas, there is no free lunch. Imagine a product that is half commission. How can an insurer afford to sell you something that is half commission?

Hint: it is not by undercharging for the product.

 What’s the Real Message?

As much as every broker and I want them to be, your employees are not benefit experts. Let’s be frank: your HR team probably isn’t either – at least most aren’t. In fact, your employees hate dealing with benefits, particularly the insurance side, so much that they spend an average of eighteen minutes making open enrollment decisions. By contrast, they will spend four hours on the decision to buy a cell phone. Priorities.

No array of glossy brochures, automated video open enrollment meetings, or highly entertaining broker personalities [ahem] will drastically change that. A fantastic broker and presentation package might get their attention for forty-five minutes. And I know because I regularly do [smiling].

When we add V.D. (what I call voluntary dental) to your plan, as an example, we will divert attention away from where eighty percent of your benefits budget goes – toward medical. Why would we do that? Of course, if all you offer is medical and V.D., that is not a problem. But most employers offer employer-paid medical, life, dental, vision, employee assistance programs, and disability. Communicating that to employees takes the entire forty-five minutes. If we attempt to add the laundry list of other items from earlier in the article, we confuse and frustrate your audience.

But what else are we effectively saying?

Our benefits are not good enough to cover you and your loved ones should tragedy befall you or your family. Sure, we offer you a few employer-sponsored items, but you probably need to buy all the other items this pushy salesperson is here to deliver. There is a watering-down effect, and you taint the vital quality plans like group disability and medical with the lottery-esque nature of cancer or accident policies. It’s what my 20-year-old daughter would call a “low-key dis.”

Pro Tip: Brokers don’t buy the laundry list of benefits. Brokers buy medical, disability, and life if we have dependents and are in a phase of life without enough assets to cover mortgages and college tuition. Everything else is superfluous. One of the best things we can do as insurance and human resources professionals is to help educate our employees on the real need for insurance. Insurance is for the huge risks we cannot plan for or save for: death, disability, and serious medical issues. We can and should be able to save and plan for dental, vision, accidents, pet issues, etc. If one can’t, then they just aren’t trying. If you set aside the money you’d pay in premium toward your dental, vision, etc., you will have that money when the need arises; and you will not have to hand over 15% to 50% in commission and another 10% for carrier profit.

Administrative Hell

Much like third-party administrators and human resources information systems, voluntary benefit providers systematically over-promise and under-deliver. Here is a partial list of what every employer should expect when installing new voluntary benefit plans:

• The carrier will not enroll all of your employees correctly. There will be some with misspelled names, incorrect dates of birth, wrong benefit plans, and incorrect family tiers. Some may be dropped from enrollment entirely for no good reason.
• This will increase the HR department's workload and hours will be spent on the transition. It will also cause disruptions to the organization due to meetings, forms that need to be completed, and the inevitable discontent from some employees.
• If a company is going to add voluntaries, the CEO or other high-ranking executive should announce the change - and the business reason why - before the meetings.
• Depending on the type of product you offer, you may have to meet minimum participation levels. This means, for example, if 20% of your employees don’t elect to buy additional life insurance, you will not be able to offer it to any of them. And you may have just had 15% of them sign up. Now you get to go back and tell those 15%, “nevermind.”
• The first bill will not be accurate. The client must audit the first bill immediately upon receiving it and notify the carrier of changes. A binder check for the first month's premium is required with the master group application and will be credited on the first or second billing cycle. Therefore, your first few bills are not likely to be accurate.

And that list assumes you already boast a savvy and robust HR team. If you have new or inexperienced folks on the team or if you experience regular turnover in HR, these matters can grow unruly in a hurry.

One Midwestern company I worked with churned through three different benefit managers in eighteen months. HR was responsible for sending an evidence of insurability form to employees who applied for more than the voluntary life’s $100,000 guaranteed issue amount. That crucial detail was lost in the shuffle. So, tensions rose when the employer experienced the death of an employee who thought he’d purchased $300,000 of life insurance, and the carrier asked the employer where the evidence of insurability was. I’ll shortcut to the answer: to make the deceased widow whole, the employer had to self-fund the additional $200,000 in life benefits, and the Director of Human Resources lost his job. A forgotten form from a benefit manager on a voluntary life plan ended a career and cost this employer $200,000.

If you are reading this and unsure what an evidence of insurability is, do not offer voluntary benefits. That risk is too significant for you and your organization at this time. If you are going to provide voluntary life or disability, make darn sure that your broker explains these potential nightmares to you.  

 Compliance Nightmares

Beyond the previous chilling story, a whole other compliance issue can arise with voluntaries. Suppose there happens to be a legal dispute between one of your employees and your voluntary vendor. In that case, that vendor will almost certainly argue that the plan is covered by Employee Retirement Income Security Act (ERISA) and that the employee’s lawsuit should be filed against the employer instead of the insurer. If the court agrees, the legal burden shifts to the employer. And in case you were wondering, yes, this one also gets HR folks fired. Courts regularly rule that a voluntary plan is an ERISA plan, even if the employer never intended to sponsor the plan formally.

And if that happens, and the plaintiff’s attorney is worth his salt, they’ll also file claims against the employer for all the ERISA reporting, disclosure, and fiduciary requirements that weren’t followed.  Two of those penalties would be:

• $149 per day penalty for failing to provide Plan Document and SPD; and
• $2,097 per plan per day for failing to prepare and file Form 5500.

Furthermore, the legal standard for what mandates that ERISA covers a plan is not a bright-line test.  It is akin to the federal employee vs. independent contractor standard, if you are familiar with that.  It is a “totality of circumstances” test that requires the plan to:

• be completely voluntary without any employer contributions;
• not allow the employer to endorse or “take credit for” the plan;
• not allow the employer to receive consideration for collecting and remitting premiums;
• not use the employer’s name, or associate the voluntary plan with the employer-sponsored benefit plans;
• not communicate the voluntary benefits at Open Enrollment with all of the employer-sponsored ERISA-covered plans;
• not recommend the plan to employees;
• never say ERISA applies;
• not allow the use of the employer’s cafeteria plan; and
• not assist employees with claims or disputes.

In some cases, judges ruled that employers endorsed plans because they announced the programs in memos written on company stationery. I’m reminded of the old Jeff Foxworthy routine, ya might be a redneck ERISA if …

 

Failing any of the above bullets might make your plan an ERISA plan, depending on the court’s assessment of the action's severity and/or frequency.  Of course, failing to abide by more than one further tips the scale in the direction of ERISA.

Benefit attorneys who litigate these types of cases regularly report that 80% to 90% of voluntary benefit plans are, in fact, ERISA plans once litigation commences and the voluntary provider makes this reflexive initial motion.

And With All of That, There Are Some Places for Them

With all that said, is there ever a time when voluntary benefits are a good idea? Yes, they can be appropriate and even desirable in a handful of circumstances.

Voluntary home and/or auto insurance is often just a link to a carrier that employees can quote themselves. It is done at any time of the year and regularly gets employees an additional 5% to 10% off, in addition to any other discounts for which they may qualify. Employers regularly can and do stay out of these offerings.

Pet Insurance. As with home and auto, it is typically just a link to a vendor that can and will offer your employee a modest discount because they work for you. Like with home and auto, I’ve never seen a pet plan morph into an ERISA plan.

Voluntary Group Life and Disability. These are often no-brainers. Notice that I said group coverage here. I do not like the idea of individual, 1099’d, 100% commissioned enrollers sitting across from your employees and asking them what momma and the baby will do when they die.  No, this is the option to buy additional life and disability above and beyond the core employer offering. We communicate it in a group setting, and then treat it like an ERISA plan as it is linked to your underlying life and disability. But know, all my caveats in this piece's “Administrative Hell” section apply. If you don’t have a seasoned, stable, savvy HR staff, you may want to consider holding off on these lines for a bit.  

Union Demanded Plans. Other than what I’ve mentioned here, I’d pass on the voluntary stuff. But I do know that there are times when a workforce demands it. I have seen that from time to time in union environments. In that case, partner with an exceptional broker to find a voluntary provider with a long, stable track record. Believe it or not, I have encountered those in my career. They aren’t totally fictitious unicorns but are exceedingly rare, glorious beasts to behold in the wild. 

Dagny Taggart is a retired and recovering broker and attorney who spends most of her days in a walled compound in Galt’s Gulch, Colorado, walking her Labrador and watching the squirrels cavort. After a 30-year career in benefits, she retired in her early 50s and now consults with large employers and brokerages on healthcare, benefits, and ERISA.

How Weaponized Corn Syrup and Diabetes Water Permeate Taxpayer-Funded "Nutrition"

Healthcare and processed food are the two largest industries/employers and lobbyists in the United States. Pharma alone spends five times what the oil industry spends on lobbying and three times more than any other industry. Congress, the FDA, USDA, CDC, HHS & CMS will not bite the hand that funds them. To be sure, from time to time, well-meaning government classers do question the status quo and make noises indicating that they might do the right thing. They are swiftly crushed.

In 2010-11, members of Congress questioned whether U.S. taxpayers should be paying for Diabetes Water (soda) for Americans on food stamps (officially now called SNAP, Supplemental Nutrition Assistance Program). Note the word NUTRITION.

The Ten Companies Controlling Nearly All We Buy in a Grocery Store

Fifteen percent of Americans rely on SNAP for their “food.” Seventy percent of SNAP dollars are spent on highly processed garbage (essentially, what you find in the middle aisles of your grocery store – stuff that didn’t exist pre-1900). The number one SNAP expenditure? You guessed it – Diabetes Water! How did the company whose product was formerly spiked with cocaine decide to handle the matter? Why with more lobbying, of course!

They deployed their billions to call African American and Hispanic interest groups. They noted that the Diabetes Water Industry would like to share some of its resources with those interest groups, assuming said interest group wanted to support “low-cost calories and choice for its members.” The other implication floated was that Congress’ contemplation of eliminating soda from SNAP smacked of racism. Of course it did.

But they weren’t done there. Big Diabetes lobbyists then reach out to right-leaning legislators and interest groups to point out that the Big Government Nannyists were at it again, wanting now to micromanage what people could drink right here in the formerly free, good-ole, U. S. of A!

The result? Yeah, you know. Soda (or do you say pop, ya heartlander) remains the top food product purchased with taxpayer-funded nutritional subsidies.

And this is just about food stamps. Meanwhile, school lunches have regulatory controls that limit the amount of saturated fat those meals can contain. Cattle ranchers and pig farmers clearly aren’t doing their fair share to buy a legislator. Sugar’s upper meal limit? Infinity.

Need more evidence? This is the latest taxpayer-funded food pyramid advice, indoctrinating that Frosted Mini-Wheats and Lucky Charms are healthier than beef or eggs. 

This is a crime against humanity. Do I care if people want to guzzle Diabetes Water or gobble Diabetes Kibble? No! The state should not be involved in any of this. But to the extent that it is and to the extent that I’m forced to pay for others’ “nutrition,” that advice and food should not poison them.

For more on this story, check out this interview with insider-turned-whistleblower @calleymeans and @KenDBerryMD. He gets right to the juiciest nuggets toward the very beginning of the video. Diabetes Water hired Calley to cultivate a list of civil rights organizations and African American pastors to fan the flames of racism whenever Congress stepped out of lined and threatened to curtail taxpayer funding of weaponized corn syrup.

I also publish long-form work on other topics; you can sign up here at my new Substack covering bass fishing, writing, and life. https://gottwals.substack.com/

How We Find and Accept the "Truth"

I thought this piece from J. Sanilac was superb on the topic. I particularly dug his list of twenty "techniques that can help us to navigate the chaotic sea of character and find the truth." 

In his Substack Trust Networks: How We Actually Know Things: 

1. Stop pretending ad hominem judgments are irrational and avoidable. Instead, accept that they're necessary and use them consciously and intelligently. As I explained in Part I, even the smartest and best informed person needs to rely on ad hominem judgments for much of his knowledge. If you pretend you can know everything directly, or even that you can suspend judgment for any question you haven't answered directly, you'll only sink yourself deeper into delusion, and your beliefs will be less rather than more accurate.
2. Don't delude yourself into assuming your own claims will be evaluated entirely on their merits. Instead, accept that you too will be the object of ad hominem judgments, and these judgments will significantly impact the reception of your claims. To be an effective knowledge disseminator you should signal trustworthiness with your track record, your outward presentation, your credentials, your character, and your alliances. Even if he has a brilliant idea, a man with no credentials, no connections, shabby clothes, and poor interpersonal skills will lose far more time lobbying to get that brilliant idea taken seriously than he would have spent if he'd polished his signaling first. Businessmen and politicians understand this intuitively. Unfortunately the kinds of men who invent important new ideas usually do not, perhaps because it's precisely indifference to signaling and partisanship that enables them to discover what other people overlook.
3. Use the black box method to test claims whose details you can't understand or evaluate directly. Just check the final outputs: if they're good, the information within the box is probably good too; if they're bad, the information within the box is flawed at best, and likely wrong.
4. Evaluate your sources' record. Do they have a history of making accurate predictions or producing good practical results? Those who've been right in the past are likely to be right again. And you too should try to build a track record of reliability, because in the course of time it will add weight to your claims. However, there's an important caveat, which I'll explain below.
5. Distrust prestige transfer. Some public figures try to leverage their record of success in one domain to create the impression of reliability in another, unrelated domain. For instance, someone who's distinguished himself as a linguist or chess player might try to transfer the prestige he's accrued in his original field to a new field, like political theory, where it hasn't been honestly earned. But success in different domains requires a different cognitive style, different strengths, a different knowledge base, and years of different experience. It's not uncommon for successful CEOs to have naive views about topics that don't directly impact their business operations. You can't assume the composers of masses are experts in theology, nor vice versa. So prestige transfer should awaken your distrust.
6. Evaluate your sources' incentives and disincentives. Sources who are incentivized for telling the truth are inherently more reliable. Yet when it comes to topics of public relevance, they rarely exist, and the best one can hope for is to find sources who aren't too highly incentivized for lying. Of course, a few rare people do compulsively seek and tell the truth due to an innate altruistic instinct, but they usually lack the motivation to explore complex topics in depth, and are therefore less useful than one would wish. (As previously mentioned, betting markets are an attempt at solving this problem.)
7. Evaluate your sources' cognitive styles and use this information to interpret their claims. Some people tend to be paranoid and overstate possible negative outcomes, others are indisciplined and jump on new ideas without thoroughly examining them, others are especially prone to partisanship, others are stubborn and never back down when they're wrong, etc. By identifying the character of a speaker you can estimate the risk he'll make a habitual error or exaggeration, and use this to translate his claims into a more accurate form. For instance, a paranoid thinker can be expected to overestimate risk, treating low probability futures as if they're matters of pressing concern, so when absorbing his warnings (e.g. about asteroids) you should downgrade their urgency.
8. Build a stable of trusted sources. Because past record is a good indicator of present reliability, it's important to observe your sources over a period of years. This is a time-consuming process by nature, so when you discover a reliable source you should consider him a valuable long-term acquisition.
9. Lower your confidence in the most popular sources. Sources and claims that are afflicted by higher than average epistemic load are amplified, especially in the social media ecosystem. Because of this the most prominent people are not the most reliable people. You should interpret great popularity among the general public as a negative sign with respect to trustworthiness.
10. Give obscure outsiders a chance. If you always follow the obvious signals of trustworthiness, like credentials, respectable presentation, and uniformly palatable opinions, you'll sometimes trap yourself in a cul de sac of mutually reinforcing conformists who've shut out dissenters. Once in a while you should make a foray into the wilderness, because obscure and disagreeable outsiders who are ridiculed, denounced, ostracized, and shamed by the mainstream occasionally are right when everyone respectable is wrong. Usually, of course, they're a waste of your time.
11. Estimate the effect of signaling load and attempt to correct for it. Comb through all your beliefs to determine which function as positive social signals, and lower your confidence in these beliefs. You should lower your confidence even more if you've fallen into the habit of using them as signals yourself. Of course, they might be true; but the expected pattern is for them to be exaggerated in the direction of optimal signaling, and they could even be empty fabrications. You should also raise your confidence in beliefs that send negative signals. It's likely that some of these are correct, but socially unpalatable, and therefore unfairly denounced. Of course, it goes without saying that you should try to avoid overcorrecting. (Note that a dissident subculture isn't immune to signaling load, but rather develops its own local signals that aren't functionally different from those of society at large. Thus, being a dissident, or contrarian, or minority does not in any way exempt you from the need to correct for signaling load.)
12. Estimate the effect of partisan load and attempt to correct for it. Most people already assume the truth falls somewhere between the extreme statements of opposing factions, so it might seem that correcting for partisan load is as simple as embracing moderation and aiming toward the center. However, this type of lazy centrism isn't actually a good way to find the truth. Political actors are experts at manipulating it. For instance, as we discussed earlier, they can use propaganda to portray their favored views as normal and centrist even if they're partisan minority views in reality. They can also can encourage their extremists to be more extreme in order to move the perceived center closer to their side. (E.g. Trust Network A says the answer is 1, Trust Network B says the answer is -1, a lazy centrist concludes the answer is 0. Whence political operators in Trust Network A can use a common sales tactic to get their way: by overshooting and claiming the answer is 3, they cause lazy centrists to conclude that it's 1, their original desideratum. Because they're vulnerable to this tactic, lazy centrists can actually encourage extremism!) There are, furthermore, plenty of historically verifiable cases where one side turned out to be wholly correct and the other wholly wrong, so that centrism would not have arrived at the truth. Thus, when you try to correct for partisan load, you shouldn't just take a moderate position between two sides and stop there. It's better to analyze the effects of partisan load carefully first.
13. Don't assume that partisanship as such is bad. Partisan load does degrade the accuracy of our beliefs, but that doesn't necessarily mean you should reject partisanship. The reason partisanship isn't wholly bad, and indeed the reason it's a natural instinct in the first place, is that it's entirely possible—even likely—that an enemy is really your enemy. In other words, one trust network may be a real antagonist whose members really wish to deceive you and do you harm because they have interests that are contrary to yours. Humans are individuals who exhibit tribal coherence. If you insist on being naive and judge everyone only as an individual, you and your allies risk defeat, and in the worst case, even annihilation. Someone who encourages you to ignore partisanship when a genuine conflict is underway is not your friend, but your enemy, or at best a fool. Before rejecting partisanship you should evaluate the whole landscape in detail and choose a side if need be.
14. Hide or camouflage unpopular views and signals of partisan alignment when trying to communicate to moderates, opponents, and general audiences. If you send the wrong signals or create the wrong associations you'll trigger an immediate rejection of your claims, no matter how good or true they are, because you'll be identified as an enemy and therefore dismissed. One solution to this is to focus narrowly on your issue of interest and avoid addressing other topics entirely. This prevents any controversial or partisan-aligned views you may hold from becoming a divisive distraction and reducing your impact. Another tactic is to advocate for positions that are more moderate than your actual beliefs, pushing for a direction and then pushing again rather than selling your ultimate target up front. Both of these approaches are in common use.
15. Use your instincts. We have fine intuitions for making ad hominem judgments in context, and the rational judgments we make in the abstract are quite myopic in comparison. Good instincts are a serious asset, so if you have them you should value them. This is not, of course, to say that they can never be wrong.
16. Use sensory information. Factual information is conveyed most efficiently in text form. However, information about the human subjects who transfer this factual information is conveyed most efficiently in audiovisual form, and some of the information that can be found in appearance and voice is completely absent from text.
17. Look out for hackers. Look for signs that someone is intentionally manipulating ad hominem signals to induce trust or distrust where they aren't merited. Unfortunately it's not always possible to identify bad actors before they've done harm.
18. Be forgiving of humans who are in the grip of bad ideas. I'm not so keen on this one myself, dear readers, but I feel at least obliged to mention it in order to signal care. All of us have some wrong and indeed outright stupid ideas we can't recognize as such. This isn't necessarily because we're stupid ourselves, although often that is indeed the case. Rather it's because ad hominem judgments, while unavoidable, are an imperfect source of knowledge, and they can't be relied on to filter out every bad idea percolating through our trust networks. We ought to be forgiving of others who are also in the grip of foolish ideas thus acquired, especially when they're young and inexperienced.
19. Avoid overconfidence. It feels good to be confident in the beliefs of your trust network. But for the reasons just mentioned, it's inevitable that this confidence will sometimes be misplaced. If you want to form a probabilistically accurate picture of the world you should abstain from the joy of overconfidence, and always remain open to the possibility that some of your beliefs are false. In fact, it's safe to assume that some of your beliefs are false.
20. Read fiction. As a writer, of course I would tell you to read fiction. So obviously you shouldn't trust me. But the reason I've littered this essay with so many examples is that, outside of real-world experience, narratives are the best means we have for thinking about and understanding ad hominem judgments and trust networks. Trust is the stuff novels are made of. Even cheap soap operas often take trustworthiness and trust networks as their main topic, with the drama unfolding around questions like: who's conspiring with whom, who's really on whose side, who's lying and who's telling the truth? If you keep your nose buried in numbers and make the mistake of dismissing everything else as wordy nonsense, you might end up trusting the wrong people and pay the price for it.

Rackets, Rods, Radio Ranches & BOR Letters

After losing to Jimmy Conners sixteen times in a row, Vitas Gerulaitis finally broke through and beat his relentless tormenter. In the post-match press conference, Gerulaitis said, "And let that be a lesson to you all. Nobody beats Vitas Gerulaitis 17 times in a row.”

Rods, Insurance, and Racquets

When the original partners of Liberty Benefit Insurance Services of Los Gatos, California, Dixon Greer and Ryan Kennedy, began selling insurance together in the early 1990s, they failed to make one sale in their first 23 prospect meetings. When I started in insurance, I went nine months and made over 10,000 cold calls before closing a sale. In 2011, Greer, Kennedy, and the rest of the Liberty Benefit team sold the business to BB&T (now Truist) for more than we ever imagined possible back in our winless days. 

... this one is more about perseverance, grit and passion than insurance, per se. Head on over to my Substack to read the full story.  

On German Accident Insurers, Snowflakes and Obamacare’s Price Controls

Something struck me as peculiar in Friday's Armstrong and Getty radio program.  It was in hour two, on “Geeks and Playgrounds.” 

They covered this story from Reason: German Insurance Companies Demand Perilous Playgrounds So That Kids Can Learn About Risk. 

My first question was, who is calling for this?  Health insurers or property and casualty insurers, or both?  

Turns out it is not the traditional health insurance market, but accident insurers. I think of accident insurers as more closely aligned with property and casualty since they pay you for harm done after the fact instead of covering medical costs as you go.  But it doesn’t matter for this analysis; I just found that interesting. 

The Reason article states:  

With young people spending an increasing amount of time in their own home, the umbrella association of statutory accident insurers in Germany last year called for more playgrounds that teach children to develop 'risk competence.’

Insurance lets you purchase a piece of mind for risks that make you uncomfortable.  Ideally, it is for risks you know you cannot cover alone.  Of course, it is also used for risks that would be too painful to cover, such as if it required you to sell your home or your fist born.  I always start there.  Most white-collar folks who make more than $100K annually should buy the highest deductible they can stomach for home and auto insurance. 

Furthermore, unless an employer pays for all or most of it, there is no need for dental or vision insurance.  Those are risks we can assess and should have enough savings to cover.  Paying an insurer to do so inserts a middleman, pays them a profit and leaves you worse off. 

What do we need? Medical and disability insurance.  We also may need life insurance if we have dependents.  Eventually, you should get to a point in life where you no longer need it.  I.e., kids out of college, home paid off, some savings in the bank.  At that point, your dependents will be fine with your assets.  

My second question was: why do German accident, property, and casualty insurers want Germans to be better with risk?  My initial instinct tells me that this was against their interests.  Snowflakes who grow up cringe harder and fear more.  Thus, they will buy more insurance, even if it is irrational.  And that generates larger profits for insurers.  But then I realized I was likely thinking too long-term.  Publicly traded corporations may talk in terms of three to five-year plans, but in reality, they had better show growth this quarter lest they want to get a public spanking.

The article does go on to state, "children who had improved their motor skills in playgrounds at an early age were less likely to suffer accidents as they got older."  That does lead one to believe that this is about profitability.  But I still don't fully buy it.  Why?  Because as soon as they begin to see more accidents due to a wincing, flaccid populace, they can justify higher premiums and make more profit. 

Granted, property and casualty insurers use different loss ratios than health insurers, but the following analogy illuminates the point.  In America, it is widely accepted that insurers can make a modest and reasonable profit at an 87% loss ratio.  That means the insurer pays 87 cents in claims for every dollar collected in premium, leaving 13 cents on the dollar to pay salespeople, train staff, hire administrative folks, pay rent, and pay taxes.   

Obamacare's Perverse Unintended Consequence

 In 2009 and 2010, legislators decided it would be a good idea to regulate the profitability of health insurers in America.  To those ends, Obamacare mandates that large insurers maintain loss ratios of 85% or more.  If not, they must rebate a portion of the premium to policyholders.  The minutia of how those numbers are calculated and disbursed is mind-numbing, so I'll spare you that here. 

 This effectively means insurers will only retain 15 cents on the dollar.  And from that 15 percent, they must pay all business costs.  If they miss and come in at an 82% loss ratio in their state, they must rebate 3% to get to 85%.  If they underwrite incredibly lean (and never do) and hit an 88% loss ratio, they may not even make enough to cover costs.  To be sure, it’s a small eyelet to thread.

 So how does Purple Cross make more money in this environment?  With more claims, of course!  If I only get to keep 15% of a pie, I’d much prefer a billion-dollar pie to a million-dollar one.  So yeah, have at it employer and employees.  Run up as many claims as you want.  We’ll jack premiums and eat more.  Oh, and for good measure, Purple Cross can also cut things like fraud detection and customer service training.  Those simply eat away at the 15%, and the U.S. market is already an oligopoly, so where will you run to, Mr. Consumer?  Purple Shield, Green Cross, how about Emperor Wilhelm?

 Back to Deutschland

What is really going on in Germany?  I’m not entirely sure.  If I take my tinfoil hat off and make an effort to be altruistic (just for a minute, Ayn. It’s just a thought experiment!)  I might conclude that the German insurers are genuinely doing what they think is best for their nation.  I mean, it is still possible for mega-corps to do the right thing for the right thing’s sake, isn’t it? 

Just kidding.  It is likely something a little deeper.  Actuarial tables are complex sets of data tasking actuaries and, eventually, underwriters with the “art” of assessing risk.  Yeah, it is more of an art than a science, as much as they want you to believe it is perfectly cold and calculated.  Don’t get me wrong.  Their job is, as my buddy Gary would say, “harder than a whore’s heart.”  But there is so much wiggle room in there that if policyholders knew how the sausage was made, they’d likely go vegan.  And don’t think for a minute government actuaries do any better.  For example, when Medicare and Medicaid first passed in 1965, government bean counters told us it would cost $12 billion by 1990. In reality, it was $110 billion. 

“Missed it by that much.”

More recently, Obamacare originally had long-term care insurance embedded within.  But the reality on that line of coverage is that folks are living so much longer now, in old folks’ homes and in need of continual care, that the industry still has not come up with a reliable way to assess this risk.  Hence, congress repealed Obamacare’s LTC program before it ever got off the ground.  Californitopia also recently eliminated its LTC coverage in CalPERS. 

The point is, as much as I want to believe insurers can simply raise premiums to cover increased risk, it’s not something that easily happens overnight.  And the one thing that insurers hate more than anything is … the unknown.  If they can’t measure and assess it, they pull the product or jack the rates so high that nobody wants to buy.  Obamacare cemented that trick for American health insurers: 

“If You Like Your Plan, You Can Keep Your Plan

Sure, you can keep it so long as you can afford the premium increases, your employer doesn’t change carriers, and your carrier continues to offer the same obsolete plan even though they are now required, in every state, to license a whole new litany of plans that comply with Obamacare’s mandated bloat.  Easy peasy.

The Patient Disruption and Unaffordable Care Act made a rule that mandated insurers always renew coverage at year’s end.  Pre-2010, your insurer could cancel you if you had an epically bad year.  Obamacare fixed that.  Now, carriers issue 75% renewal increases to accomplish the same thing.  Problem solved. 

Conclusion(s)

I’m left with three possible conclusions as I ponder this story: 

1.      (1) If German accident insurers operated under the same warped, public-private partnership (i.e., fascistic) rules as Obamacare, not only would those insurers display indifference toward greater childhood risk-ignorance, they would foster it.  That would lead to more claims and be the only way German insurers could generate more revenue in the future.  Again, 15% of a billion is much better than 15% of a million.  Aren’t price controls neat?

2.      (2) Enough cynicism. Let me white pill this for a moment.  It is certainly possible that the insurers want what is best for Germany.  And, as they look across the pond to their WWII liberators, they see what happens when you fastidiously bubble-wrap your youth in endless layers of protection. It’s not good. Good times are definitely creating weak men.  So, at least on its face, there is an argument that the Deutschlanders are solely doing what is right for their youth. 

 

3.     (3)  This brings me to my third and most likely conclusion.  Germany’s carriers are horrified at the speed at which the namby-pamby are changing risk calculus.  Hence, Germany’s plea to allow more risk and play on more dangerous playgrounds is more likely tied to the bottom line.  It is not our Obamacare analogy or altruism; instead, it is most like our U.S. long-term care calculus.  In their eyes, if people become more paranoid and want to buy more coverage for perceived risks, great.  But let’s not do this overnight because we still must have some clue as to how to underwrite our precious little snowflakes in the short term.  For a carrier, claim expansion is great for business over the long haul if it is predictable and can be ushered in with higher premiums.  But the market will topple when the claims skyrocket in a short enough period (like 1 to 3 years). 

Alas, this third conclusion is actually the scariest.  Accident insurers (at least in Germany) are signaling that the wussification of our youth is happening so fast, they are not confident in their ability to profit from it.  It’s bad enough that we bubble-wrapped our snowflakes as we hover over them in helicopters to ensure nothing bad ever happens.  But we’re doing it so fast that the oligarchs and the oligopoly are worried that our degradation will infringe upon their ability to plunder from our demise. 

 

The Lifelong Power of Close Relationships

From Robert Waldinger and Marc Schulz writing at the WSJ: 

... What if we could study people from the time that they were teenagers all the way into old age to see what really matters to a person’s health and happiness, and which investments really paid off? For 85 years (and counting), the Harvard Study of Adult Development, which we now direct, has tracked an original group of 724 men and more than 1,300 of their male and female descendants over three generations, asking thousands of questions and taking hundreds of measurements to find out what really keeps people healthy and happy.

Through all the years of studying these lives, one crucial factor stands out for the consistency and power of its ties to physical health, mental health and longevity. Contrary to what many people might think, it’s not career achievement, or exercise, or a healthy diet. Don’t get us wrong; these things matter. But one thing continuously demonstrates its broad and enduring importance: good relationships.

In fact, close personal connections are significant enough that if we had to take all 85 years of the Harvard Study and boil it down to a single principle for living, one life investment that is supported by similar findings across a variety of other studies, it would be this: Good relationships keep us healthier and happier. Period. If you want to make one decision to ensure your own health and happiness, it should be to cultivate warm relationships of all kinds. ...

[I]t wasn’t their middle-aged cholesterol levels that predicted how they were going to grow old; it was how satisfied they were in their relationships. The people who were the most satisfied in their relationships at age 50 were the healthiest, mentally and physically, at age 80....

[F]or older people, loneliness is twice as unhealthy as obesity, and chronic loneliness increases a person’s odds of death in any given year by 26%....

Just 2 Minutes of Intense Exercise Every Day Could Extend Lifespan

From StudyFinds: 

The first study included 71,893 adults without cardiovascular disease or cancer. The median participant age was 62.5 years old, and just over half (56%) were female. Study authors measured weekly levels of vigorous activity and the frequency of exercise bouts lasting two minutes or less. This was a long-term study; subjects were tracked for an average of 6.9 years.

Then, associations between volume and frequency of vigorous activity with death (all-cause, heart disease, and cancer) and incidence of heart disease and cancer after excluding events occurring in the first year were analyzed by researchers. Sure enough, as both the volume and frequency of vigorous activity increased, risk of all five considered adverse outcomes declined. ... 

[S]ubjects who didn’t exercise vigorously at all had a four percent risk of dying within five years. That risk was cut in half (2%) with less than 10 minutes of weekly vigorous activity. Death risk fell to one percent with 60 minutes or more.

When compared to two minutes of intense exercise per week, 15 minutes of vigorous exercise was associated with an 18 percent lower death risk and a 15 percent lower risk of cardiovascular disease. Meanwhile, 12 minutes was linked to a 17 percent lower risk of cancer.

Generally, the more exercise the better. For example, roughly 53 minutes of physical activity on a weekly basis was associated with a 36% lower risk of death from any cause.

Employers Expect Major Increases to Health Care Costs in 2023

In 2022, most employers’ healthcare costs increased. According to recent industry data, current signs are also pointing to significantly higher healthcare costs in the upcoming year. Employers now face the difficult task of reigning in rising healthcare costs and keeping employee coverage affordable while trying to remain attractive to current and prospective talent despite their shrinking budgets.

 

Many employers are worried about controlling rising healthcare costs and providing employees with affordable and quality care options. This article explores employer expectations regarding health care costs, reasons health care costs are rising and strategies employers are implementing to address increasing costs.

 

Employers Expect Health Care Costs to Increase

 

Reports from industry experts seem to agree that employers expect major increases in healthcare costs in 2023. Data from Willis Towers Watson’s 2022 Best Practices in Healthcare Survey found that U.S. employers’ healthcare costs are projected to increase 6% next year, compared with an average 5% increase experienced in 2022. Early Mercer survey results suggested that U.S. employers expect their healthcare costs per employee to rise 5.6% on average in 2023.

 

Those costs may increase even more if employers fail to take action to curb rising healthcare costs. If employers fail to make any changes—such as expanding telemedicine options and digital healthcare resources—employers believe the costs for their largest healthcare plans will grow by 7%. The International Foundation of Employee Benefit Plans reported that employers anticipate a 7.5% median increase in medical plan costs in 2023.

 

An analysis from global professional services firm Aon predicted employer health care costs will increase by 6.5% in 2023, with the average costs per employee reaching $13,800. Based on Aon’s analysis, this prediction is below the current inflation figure reported in the consumer price index, but it’s significantly higher than the increase in healthcare costs employers saw from 2021 to 2022. Additionally, HR and employee benefits consulting firm Buck found employer healthcare costs in 2023 are projected to increase between 5.8% to 6.9% in its 2022 National Healthcare Trend Survey.

 

Why Health Care Costs Are Increasing

 

There are a few reasons health care costs are increasing. While most employers had lower claim costs during the COVID-19 pandemic, medical plan costs are returning to pre-pandemic levels as healthcare utilization rebounds. Utilization has especially increased for employees dealing with severe chronic diseases and late-stage cancer due to missed or delayed care during the pandemic. Additionally, many employees are struggling with long COVID-19. Even those employees who have recovered from COVID are experiencing cardiovascular and neurological diseases, which is causing employer healthcare costs to increase.

 

Inflation is also causing healthcare costs to rise, and it will likely drive up costs moving forward; however, due to the long-term nature of provider contracts, some employers may not immediately feel the cost increases caused by inflation. In addition, the recent trend of consolidation among hospitals, physician practices, and commercial insurers is triggering higher healthcare prices for private insurance. Other factors contributing to increased healthcare costs include new technology, novel prescription drugs, specialty drugs, and catastrophic claims.

 

Employer Strategies for Managing Health Care Costs and Improving Affordability

 

Traditionally, employers have addressed rising healthcare costs by shifting increased costs onto employees through higher premiums. While some employers are continuing to implement this strategy, most employers do not want benefit choices to interfere with their recruiting efforts due to the state of the labor market. Therefore, employers are using multiple strategies to manage their healthcare costs while attempting to improve affordability for employees.

 

These strategies include the following:

 

• Self-funding more of their cots with Health Reimbursement Arrangements
• Structuring payroll contributions to reduce healthcare costs for employees
• Employing programs to combat fraud, waste, and abuse
• Increasing healthcare plan budgets
• Contracting directly with high-quality, cost-competitive hospitals and physician networks
• Requiring employees to use cost-effective medical centers or obtain preapproval for scheduled inpatient services
• Offering employees health care navigation and concierge support services
• Evaluating prescription drug costs, particularly for specialty drugs
• Providing telemedicine or virtual care services
• Implementing new benefit programs, such as wellness programs, or using vendors
• Expanding voluntary benefit offerings, such as supplemental health insurance for catastrophic events
• Supporting and effectively managing employees with chronic conditions, long-term illnesses, and complex diseases
• Seeking help from insurance brokers to detail organizational healthcare spending and educate employees on shopping for healthcare services

 

Rising healthcare costs are causing employers to reevaluate healthcare plan designs and offerings. By gathering data and using it to predict where and when increased costs may occur, employers can determine the best strategies to address growing healthcare costs.

 

Summary

 

Employers of all sizes are looking to offer quality healthcare benefits in 2023 while focusing on employee affordability and accessibility. This will be difficult as prices increase and employer budgets shrink as a result of the current economic environment. Employers can act now to proactively prepare for anticipated healthcare price increases and find long-term solutions to mitigate rising costs.

New CA Employment Laws, Trends in Rx Spending, Telemedicine Challenges and More

Benefits in Brief

Employees can put an extra $200 into their health care flexible spending accounts (health FSAs) next year, the IRS announced on Oct. 18, as the annual contribution limit rises to $3,050, up from $2,850 in 2022. The increase is double the $100 rise from 2021 to 2022 and reflects recent inflation. 

Compliance News

A Group Health Plan Without a Public Website may satisfy the new transparency and price disclosure requirements if the plan’s TPA posts the required information on its public website - (Q 11, pg. 12) Federal regulators have now made it clear that self-funded employers can rely on their administrator (TPA) to make the necessary price disclosure files publicly available so long as there is a written agreement in place. One original federal interpretation was that employers had to provide that on their websites, and if they did not have a public website, they had to create one for that purpose. Of course, that seemed ludicrous. And thankfully, regulators now agree it was.

California Expands Who an Employee Can Care for Under the CFRA and California Paid Sick Leave Law - "Beginning January 1, 2023, employees throughout California will be able to use sick leave or take leave under the California Family Rights Act (CFRA) to care for a 'designated person' ... defined as any individual related by blood or whose association with the employee is equivalent to a family relationship. An employee can designate this person at the time they request leave." 

California Unleashes Last-Minute Onslaught of New Employment Legislation - California Governor Newsom recently signed several pieces of employment-related legislation into law including: Supplemental Paid Sick Leave Extension, an expansion of the California Family Rights Act and California Paid Sick Leave, Unpaid Bereavement Leave, Emergency Working Conditions, Reproductive Health Decisionmaking, and Cal/WARN Act Enforcement for Call Centers.  

Benefit News

Trends in Prescription Drug Spending, 2016-2021 - This HHS Issue Brief presents the Agency’s findings on prescription drug spending trends between 2016-2021. 

• In 2021, the U.S. health care system spent $603 billion on prescription drugs, before accounting for rebates, of which $421 billion was on retail drugs. 
• Spending growth on drugs was largely due to growth in spending per prescription, and to a lesser extent by increased utilization (i.e., more prescriptions).
• Expenditure growth was larger for non-retail drug expenditures (25%) than for retail expenditures (13%). 
• Between 2016 and 2021, the location where people received their drugs changed. Americans increasingly received their drugs from mail order pharmacies (35% increase), clinics (45% increase), and home health care (95% increase). During the same time period, there were decreases in drugs received through independent pharmacies (5% decrease), long term care facilities (17% decrease), and federal facilities (9% decrease). 
• Drug spending is heavily driven by a relatively small number of high-cost products. The cost of specialty drugs has continued to grow, totaling $301 billion in 2021, an increase of 43% since 2016. Specialty drugs represented 50% of total drug spending in 2021. While the majority (80%) of prescriptions that Americans fill are for generic drugs, brand name drugs accounted for 80% of prescription drug spending in both retail and non-retail settings, with little change over time. The top 10% of drugs by price make up fewer than 1% of all prescriptions but account for 15% of retail spending and 20%-25% of non-retail spending.
• Prescription drug spending trends have been less affected by the COVID-19 pandemic than health care services. 
• Several provisions in the Inflation Reduction Act address drug pricing, including allowing the Secretary of HHS to negotiate prices in Medicare Parts B and D for selected medications and introducing Medicare rebates for drug prices that rise faster than inflation. These provisions may impact future drug spending trends.
• There were 1216 products whose price increases during the twelve-month period from July 2021 to July 2022 exceeded the inflation rate of 8.5 percent for that time period. The average price increase for these drugs was 31.6 percent.

Telemedicine was made easy during COVID-19. Not any more - "Over the past year, nearly 40 states and Washington, D.C., have ended emergency declarations that made it easier for doctors to use video visits to see patients in another state, according to the Alliance for Connected Care, which advocates for telemedicine use. Some, like Virginia, have created exceptions for people who have an existing relationship with a physician. A few, like Arizona and Florida, have made it easier for out-of-state doctors to practice telemedicine. Doctors say the resulting patchwork of regulations creates confusion and has led some practices to shut down out-of-state telemedicine entirely. That leaves follow-up visits, consultations or other care only to patients who have the means to travel for in-person meetings."

Health and Wellness

Sore Throat, Now the Most Common Sign of COVID - "where once a fever and loss of taste or smell were early warning signs of the bug, the symptom tracking app has revealed the most common symptoms have changed."

People who sleep 5 hours or less a night face a higher risk of multiple health problems as they age - "The study, published Tuesday in the journal PLOS Medicine, took a closer look at a group of nearly 8,000 civil servants in the United Kingdom who had no chronic disease at age 50. Scientists asked the participants to report on how much sleep they got during clinic examinations every four to five years for the next 25 years. For those whose sleep was tracked at age 50, people who slept five hours or less a night faced a 30% higher risk that they would develop multiple chronic diseases over time than those who slept at least seven hours a night. At 60, it was a 32% increased risk, and at 70, it was a 40% greater risk."

Compliance and Benefit News, October 3, 2022

Compliance Updates

CA Legislature Expands Pay Transparency and Data Reporting Requirements; Extends COVID Supplemental Paid Sick Leave - "If signed into law by Governor Newsom, the current amended version of SB 1162 would increase employers’ pay transparency obligations as follows: 1) upon request, all employers will be required to provide the pay scale (i.e., hourly rate or salary range) for the position in which the employee is currently employed; 2) employers will be required to maintain records of job title and wage rate history for all employees for the duration of employment plus three years; and 3) all employers with 15 or more employees will be required to disclose pay scales in all job postings.

SB 1162 also expands California employers’ current pay data reporting requirements, which were initially passed into law in 2020 as part of the nation’s first such state-imposed obligations. The current requirements mandate that private employers with 100 or more employees report annually the number of their employees by race, ethnicity, and sex in specified job categories to the Department of Fair Employment and Housing (recently renamed the Civil Rights Department (CRD))."

California Slated to Usher in New Era of Pay Transparency in 2023: What California Employers Need to Know - "The Act expands pay data reporting to all California employers with 100 or more employees regardless of whether or not they are exempted from the EEO-1 filing requirement. The Act also significantly expands the types of pay information employers must report each year. The first deadline to report is the second Wednesday of May 2023 (May 10, 2023). Covered employers must now also provide the “median and mean hourly rate” within each job category (discussed above), for each combination of race, ethnicity, and sex."

Benefit News

The Cost Of Long COVID To Employers Is Skyrocketing -"two types of claims were sorted out: those labeled long COVID, and those attributed to diabetes. When the numbers were crunched, here’s what came up: Per-member employer spend on long COVID was on average $2,654.67, more than 26% higher than the average diabetic spend....The study also finds that long COVID patients reported a 3.6 times greater likelihood of missing work for medical reasons than plan members without the symptoms. ... [T]he average predicted cost of long COVID to patients is nearly $9,500 within the first six months following a diagnosis."

Segal Trend Survey, 7.4% Plan Increases in 2023 - "The projected annual cost trend for outpatient prescription drugs is expected to be approaching double-digit levels, the highest rate observed since 2015. Double-digit specialty Rx cost trend, mostly driven by price increases and new-to-market specialty drugs, continues to be a major driver of Rx cost trends. Survey respondents project per-person cost trends for open-access PPO/POS plans to be 7.4 percent."

Yet Another Reason to Look at Reference-Based-Pricing (another hidden cost shift against employers) - Employer plans pay an average of 224% of what Medicare pays for the same hospitalizations. This cost shift away from Medicare and onto employers has led to growth in employers moving away from traditional insurance and reverence-base-pricing their plans. I spoke about it with Armstrong and Getty in September here. And I wrote about it becoming a growing trend in the 2020s here. A new study now shows that the same hidden tax/cost shift is happing with Obamacare Exchange plans.

‘Gaming’ Of U.S. Patent System Is Keeping Drug Prices Sky High, Report Says - Four pharmaceutical companies have filed hundreds of patents to keep their drugs out of the hands of generic competition and prolong their “unprecedented profits,” according to a report published Thursday. The excessive use of the patent system — by drugmakers Bristol-Myers Squibb, AbbVie, Regeneron and Bayer — keeps the prices of the medications at exorbitant levels, often at the expense of American consumers, according to the report from the Initiative for Medicines, Access & Knowledge, or I-MAK, a nonprofit organization that advocates drug patent reform. ... The U.S. patent system is meant to reward innovation by permitting drug companies to sell new medications on the market and barring other manufacturers from making generic versions for a set period of time — usually 20 years. Once the patent expires, generics are allowed on the market, often at a lower list price than the brand-name drug. But drugmakers often extend their patents by making small tweaks to the drugs, sustaining their monopolies for several years. Legal experts refer to this tactic as “evergreening...”

Health care spending for mental health disorders increases between 2013 and 2020 -

• Overall spending on mental health services increased from 6.8% to 8.2% between 2013 and 2020, according to a new study published by the Employee Benefit Research Institute (EBRI).
• The percentage of the population under the age of 65 with employment-based health coverage diagnosed with a mental health disorder increased from 14.2% in 2013 to 18.5% in 2020.
• Among enrollees with a mental health diagnosis, average annual spending on mental health care services increased from $1,987 to $2,380 between 2013 and 2020 — an average of 3% per year.

Physician Burnout Has Reached Distressing Levels, New Research Finds - "Results released this month and published in Mayo Clinic Proceedings, a peer-reviewed journal, show that 63 percent of physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022, an increase from 44 percent in 2017 and 46 percent in 2011. Only 30 percent felt satisfied with their work-life balance, compared with 43 percent five years earlier."

The perks that work to retain employees now - "Among employed adults, 56% say that the work schedule attracts them most in their current role ­— a factor valued more by women (61%) than men (51%). Almost half of the workers surveyed say that colleagues (48%), fair pay (46%), and work-life balance (43%) are most appealing, with 34% also appreciating their health benefits. In fact, 58% of Gen Z are attracted to their job because of colleagues and work friends, while men (52%) are more likely than women (39%) to be drawn to their job because they are paid fairly."

Health and Wellness

Antidepressants Work Better Than Sugar Pills Only 15 Percent of the Time - "Five years ago Mark Horowitz seemed an unlikely skeptic of psycho-pharmaceuticals. He had been taking the popular antidepressant Lexapro virtually every day for 15 years. He was so fascinated by the drugs that he spent three years hunched over a dish of human brain cells in a laboratory at King's College London, measuring the effect of human stress hormones and drugs like Prozac and Zoloft. Then, when he tried to wean himself off the medication, he suffered panic attacks, sleep disruptions, and depression so debilitating that he had to move back to his parents' house in Australia—symptoms that he says were far worse than anything he experienced prior to going on the drugs. He went online and found thousands of others in a similar pickle. They had been unable to kick one of the psychiatric drugs known as Selective Serotonin Reuptake Inhibitors, or SSRIs, which include Lexapro, Zoloft, and Prozac, among others. Since withdrawal symptoms were thought to be mild and temporary, many of them, like him, had been told by doctors that they were experiencing a relapse of their depression. ..."

How to maintain peak brain health: Scientists say it comes down to these 3 factors - "The three identified keys to strong brain health are:

1. Physical exercise
2. Social activity
3. Strong, passionate interests and hobbies

Simple, right? Let’s break down each factor a bit further. ..."

CDC no longer recommends universal masking in health facilities - "The Centers for Disease Control and Prevention no longer recommends universal masking in health care settings, unless the facilities are in areas of high COVID-19 transmission. The agency quietly issued the updates as part of an overhaul to its infection control guidance for health workers published late Friday afternoon [Sept. 23rd]. It marks a major departure from the agency’s previous recommendation for universal masking."

Being unhappy or lonely speeds up aging — even more than smoking - "Being unhappy or experiencing loneliness accelerates the aging process more than smoking, according to new research. An international team says unhappiness damages the body’s biological clock, increasing the risk for Alzheimer’s, diabetes, heart disease, and other illnesses. The team reports that they detected aging acceleration among people with a history of stroke, liver and lung diseases, smoking, and in people with a vulnerable mental state. Interestingly, feeling hopeless, unhappy, and lonely displayed a connection to increasing a patient’s biological age more than the harmful impact of smoking."

Reducing Employer Healthcare Costs via RBP with Armstrong and Getty

 I spent a couple of segments on the air with Joe Getty this morning discussing the very latest healthcare cost increases in and out of the exchanges, as well as how employers are fighting back by option out of the Government-Insurer-Complex madness with reference-based pricing.  

If you want to read more about reference-based pricing, I wrote about it over at Think Adviser, here.