It's high noon for worker's comp - Special Report - The 1990s: What's Ahead for Health Benefits - illustration

Business & Health, Dec, 1989 by Kathleen Doherty

Says workers' comp expert Greenwood: "More and more people are talking about deductibles, although no one has come out openly in favor of them."

Labor disagrees

Such medicine may not go down easy--especially with labor. Union officials argue that workers injured on the job are entitled to comprehensive and free care; workers' comp is a social insurance program in which employers bear the sole burden of paying medical bills, they say.

"If you put in deductibles, what you're doing is blaming the victim. That was never the intention of the workers' comp system," says the AFL-CIO's Ellenberger. "Employers are striking at the very heart of the workers' comp system."

Surprisingly, C. Clarke Imbler, senior vice president of the Alliance of American Insurers, concurs. "Deductibles violate the social contract established when workers' comp was started years ago. We don't believe that at this point the employee has to bear part of the cost of treatment."

Should support grow for employee cost sharing, the debate about deductibles would probably turn into a showdown between unions and employers--with legislators caught in the middle.

Ready to fight

Labor is already gearing up for battle. "A lot of labor people are disgusted with the whole workers' comp system. They're ready to throw up their hands and get rid of it," says Ellenberger. "If companies want to share costs, then we might say `Let's ditch the system,' and go back to the tort system.

"If companies think costs are high now, wait till they see what the courts can do," he adds.

Union officials may be drawing their swords too soon, however. Employee cost sharing would demand a fundamental change in workers' comp--a change that most experts say won't happen anytime soon.

Political risks

"No politician will stick his neck out in support of deductibles; the political risk is just too great," says Cornell University's Burton. "But I won't say that this change won't happen sometime in the next 10 years. Just a year ago, no one even dared to talk about deductibles.

"In the future, workers' comp may have to go the way of health care benefits and not be as generous with its payments. There may be no other way to go."