Possibility of True Integrated Health Care
January 22, 2007

"It just seems to make sense." That is the reaction from business owners, labor officials,
policy makers, and insurance companies when the phrase "24-hour coverage" is brought
up. Indeed, it is hard to argue that we should not have a fully integrated health care
system that provides the same benefits regardless of whether the injury or illness occurs
on the job or at home. If the idea is to truly provide the same benefits, then there is much
that could be done to streamline healthcare in California and across the nation. Of course,
our workers’ compensation system does not provide the same benefits, does it? 

First, over the decades, the Legislature has decided that many health care providers
should be "physicians" for purposes of workers’ compensation, such as, chiropractors
and acupuncturists. Second, workers’ compensation medical treatment is provided
without any contribution from the worker in the form of a deductible or co-pay. Third,
and, perhaps most important, the employer at the time of injury is responsible for all
medical treatment associated with the injury or illness for the lifetime of the claim,
regardless of whether the injured worker quits his or her job and joins a different
employer.

There are other important considerations. The California Constitution requires a complete
system of workers’ compensation, including the provision of medical treatment. The
prospect of turning workers’ compensation into a "disability only" benefit, while
intriguing, ignores the constitutional mandate adopted in California nearly a century ago. 
In addition, while employers should be able to provide comprehensive employee benefit
packages that include short and long term disability programs regardless of the causation
of the injury, such programs fall under the jurisdiction of the federal government pursuant
to the Employee Retirement Income Security Act (ERISA).  If a program is developed
that tries to integrate medical, disability, and workers’ compensation programs into one
benefit package, that package relates to a covered benefit program and, according to the
United States Supreme Court, is an ERISA plan.

We believe that it is more important to empower employers to develop integrated health
and disability programs without the fear of duplicative and costly state or federal
regulation than it is to encourage programs that are not realistic under the current state of
the law. The assumptions that went into the creation of the workers’ compensation
system so long ago are not as valid in today’s world. Until we rethink these basic
principles, however, and enact laws both here and in Washington D.C. to implement
these new concepts, we are all limited in what can be done.