Saturday, February 17, 2018

5 Reasons You Didn't Get a Bigger Raise This Year

Wage growth has been stable at 3% across the country and in Europe and Japan since we got out of the recession in 2008. Three percent doesn't allow for a lot of differentiation in salary increases across an organization, so it's likely your raises have been pretty unimpressive. It's been ten years since the economy tanked, so why aren't employers putting more money into salary increases?
Data from Quatt Associates

  1. With every employer setting salary increase budgets at 3%, employers are under no pressure to do more than that. Matter-of-fact, you look pretty irresponsible to your board if you set a much larger budget. How would you justify it?
  2. There is evidence that companies have shifted money into bonuses rather than base pay increases. Bonuses are much more nimble than base pay. It’s easier to forgo bonuses if profits are not meeting expectations than to cut salaries or lay people off.

Saturday, February 3, 2018

Tackling Health Spending

On Thursday, the National Pharmaceutical Council (NPC) and Health Affairs launched a new initiative to address health spending called Going Below the Surface. It's is a "research-first endeavor dedicated to unearthing and examining the drivers of health care spending in the United States, and convening a multiple-stakeholder discussion to better understand what we receive for these investments."  The U.S. spends 18% of GDP on health care which is far more than any other country. And, despite all that money, we have worse outcomes.

David Cutler from Havard University shared a few shocking comparisons. The one that has stuck with me is Duke University Hospital has 900 hospital beds and 1,300 billing clerks. Do you think maybe we could save some money by streamlining how we pay for care?

Amitabh Chandra from Havard University showed this cost curve to illustrate how the first health care dollars spent extend life significantly, but you quickly reach a point where we're spending half a million dollars to extend a person's life by a matter of days. This leads to the tough questions. Who decides where the time isn't worth the expense? Is there one answer for everyone in the country or could individuals choose the coverage they want? 

Wednesday, January 24, 2018

We're Dying Earlier in the U.S. While People in Other Countries are Living Longer

Our life expectancy in the U.S. decreased for the second year in a row in 2016 to 78.6 years. The drop looks small at first blush -0.1 years, but it's alarming. Life expectancy in the United States is lower than in most other OECD countries and the gap is getting wider--we're dying earlier in the U.S. while people in other countries are living longer. I could not do as good a job of explaining why as Bill Gardner did in this post, so I recommend you read his explanation. 

How are people dying? These are the leading causes of death according to the CDC.
  1. Heart Disease
  2. Cancer
  3. Accidents
  4. Chronic lower respiratory disease
  5. Stroke
  6. Alzheimer's
  7. Diabetes
  8. Flu and pneumonia
  9. Kidney disease
  10. Suicide
The rate of death decreased for seven of these 10, but increased for accidents, Alzheimer's and suicide. We also know drug overdose deaths rose an appalling 21% from 2015 to 2016

Friday, October 13, 2017

Mental Health Care -- Far From Equal

I'm reposting this with permission from Maggie McGary. She shares an interesting perspective on mental health care in this post. You can learn more about Maggie on her blog Mizz Information. I also recommend taking a look at 10+ Photos that Prove Depression Has No Face. 


Mental health has had a banner few weeks in the news and across the internet–at least when the news centers around celebrities or teens. Sinead O’Connor and Justin Bieber made headlines about their battles with depression and mental illness and Diply applauded a list of celebrities who have shared their struggles with mental illness. Two teens were lauded for documentaries about mental illness: one praised for his film raising awareness about mental illness and another whose documentary about suicide won the top prize at a film festival. Headlines like “Young People On ‘Brink Of The Worst Mental Health Crisis In Decades,’” and “Teen suicides now outnumber homicides,” and “Suicide Rate for Teen Girls Hits 40-Year High” are just a few of the too-many-to-list recent news items showcasing how teens are battling depression that make it feel–at least to me–that somehow the world is getting the message that teens are the only ones impacted by mental health issues…well, teens and celebrities.
All this buzz about mental health issues is great, but to me it just highlights a disparity I’ve already written about: the what-feels-like-a-growing-chasm between mental health stigma among celebrities and teens and then among GenX and older generations. While teens and millennials are doing a great job of being open about mental illness in an effort to stop the stigma that surrounds the subject, those of us who grew up being told that mental illness is a shameful secret that you better never tell anyone about or you’ll be labeled crazy, ostracized and probably lose your job…for us, it’s not that simple.

Monday, July 10, 2017

Critical Illness Insurance—Let the Buyer Beware

I am constantly getting calls from AFLAC representatives that want us to offer their critical illness coverage to our staff. Usually, they try to bribe their way in the door with one of those silly ducks—that's a great marketing approach if your target audience is three years old or a canine. (I hear dogs love the stuffed ducks.) Recently, a rep tried a different approach. She tried to guilt me into offering ASHA employees the opportunity to choose. Choice is a fundamental American value. Why was I denying ASHA staff the right to choose for themselves?

It's true, ASHA staff value the opportunity to choose, but they want to choose between good options. They trust me to vet what we put in front of them and I'm not going to let someone sell my colleagues swamp land. 

I did a little research online and talked to a source who shall remain nameless. The average annual AFLAC premium is $780/year. The seller makes 47% commission in the first year or over $366. Stock bonuses can be earned on top of that. In other words, half of what you're paying goes in the sales reps' pocket.

Friday, June 30, 2017

What happens when we don't see health as a common endeavor?

How much you believe in a need for universal health care is largely dependent on how much you see health as a common endeavor. The national policy debate we've been having lately and the health economics class I just completed have me giving it some thought.

Respecting people's preferences is an important tenet of economics. So, if you like to spend your leisure time watching football, smoking, drinking beer and eating pizza; we can presume that you know best what makes you happy and you alone suffer the consequences. If however, other people pay the price for your choices, then there is a social cost, and it is reasonable to consider some intervention.

Wednesday, June 21, 2017

Three Things We Should All Know About the Opioid Crisis

I attended the Vox Unconference, the World Heath Care Congress and a pharmacy summit this spring. There was one topic that overlapped the three events--the opioid crisis. It's all over the news, but so frightening, I think it bears mentioning here. Here are some things you need to know--especially if you're a parent.
  1. The risk of continued opioid use increases after 4 to 5 days. If there is a history of addiction in your family, even that amount of time may not be worth the risk.
  2. Opioids are not effective for treating chronic pain. They may work for a month or so, but the effect is likely to diminish even at increased dosages. Eventually, you'll be left with your chronic pain and a drug dependency. Some people even experience hyperalgesia, a greater sensitivity to pain after taking narcotics for longer periods of time.
  3. How pain came to be the fifth vital sign. The New Yorker ran through a good history in Who is Responsible for the Pain-Pill Epidemic. Vox reported, "US doctors wanted to treat pain as a serious medical problem. But when pharmaceutical companies pushed opioid painkillers with a misleading marketing campaign, they started a drug crisis."
Vox did a really great story on the crisis: How the opioid epidemic became America’s worst drug crisis ever, in 15 maps and charts. Please take a few minutes to scroll through it and watch the 4 minute video.