Labor Day 2007: New Face of Labor - Hired Guns

Our President has made a surprise visit to Iraq to meet with General Petraeus and assess the situation. Next Sunday, September 9, 2007, HBO will air Alive Day Memories: Home From Iraq and I have been writing about the types of injuries our servicemen and women are suffering in the Afghan and Iraq wars. We have 30,000 injured veterans of these two wars coping with disabilities today, and the HBO film by Executive Producer James Gandolfini gives us some insight into their struggle.

There is a big, new industry that has exploded along with the war on terror - that of private military/security contractors. This means new labor - and as a disability manager this is something that interests me. I can't help but wonder about their disability insurance, who pays for their injuries - are the contractors experiencing similar injuries? What happens when they do get injured? I am reading a fascinating book this weekend, Robert Young Pelton's Licensed to Kill: Hired Guns in the War on Terror - just a little light summer reading every American who wants to know what's going on with our world might want to read. Mr. Young has a link on his website for Insurance which takes one to Ingle International and Imagine Ltd. where one can purchase Special Risk Product insurance. The Specialty Insurance or KRE to those in the know, provides protection against "...kidnap and extortion..when traveling to dangerous places". Need it be said, "War is not an insurable risk," per Bruce Wood, of the American Insurance Industry.

Blackwater is the most well known of the private military contractors who provide"...security, peacekeeping, professional military and stability operations..." for profit. Contractors are former military, police officers,CIA, Special Forces agents and Navy SEALS. Triple Canopy is another - they seek Quiet Professionals and have openings in Emergency Medicine and IT for those of you looking for adventure.

Well, thank you Joseph Neff, Staff Writer for the (Raleigh Durham) News & Observer to Lynch Ryan over at Worker's Comp Insider for getting to the bottom of this issue. Questions like this really plague me and I lose sleep until I know the answers.

• 126,000 private contractors work for the US government in Iraq
• 1000 have died
• 13,000 have been injured
  
• Each is insured against injury or death on the job
• US taxpayers pay both the insurance premiums and the benefits thanks to two WWII era laws:
• 1941 Defense Base Act requires contractors to be insured
• 1942 War Hazards Act allows the insurers (not the insured) to apply to the US government to cover payments for contractors injured or killed
• No one is overseeing the amount the insurers are charging the government - so they are charging "exorbitant premiums" per Bunny Greenhouse, of the Army Corps of Engineers
• Greenhouse initiated the practice of competitive bids in 2005
• she fought down the minimum premium from $25,000 (even if the assignment was 2 weeks!) to $7,500
• because of her advocacy we no longer have "a monopoly price and a monopoly vendor"
  
• No agency regulates the premiums or tracks the costs
• Even the Government Accountability Office (GAO), the congressional watchdog agency, was unable to calculate the costs to taxpayers.
• The contractors insurance market is dominated by AIG

Dyncorp International has hired Mission Critical Psychological Services to help its employees who struggle with post-traumatic stress disorder (PTSD) upon completion of their assignments. Mental health issues are going untreated in private contractors returning from Iraq. Insurers are fighting the claims, and the civilian mental health community is ill prepared to deal with combat-related stress. AIG has paid about 50% of the PTSD claims filed.

This is one of those rabbit hole stories - the more you know, the more you realize you don't know. For more reading and to understand a new face of labor, visit AmericancontractorinIraq.
Happy Labor Day, whatever you do!

Thank you Jimmy theSuperstar for Iraq picture.

Labels: insurance, Iraq, military, private contractors, security

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SICKO: An Industry Insider's View

I saw Sicko yesterday and have to admit, I laughed when MM commandeered boats to Guantanamo to seek care for sick 9/11 heros and cried when he took them to Havana Hospital. Now the US Treasury Department and Michael Moore are investigating each other over this alleged infraction of US laws, and the people who went on the trip have signed privacy agreements so they aren't talking. 47 million uninsured Americans is wrong and we need to fix it. But Moore's film isn't exactly fair and balanced.

The Sicko doctors in managed care who were disgraced worked in one aspect of insurance called Utilization Review. I worked in insurance for several years but always refused to work in UR for the very reasons cited - UR denies "payment, not care." I preferred being one of the people who advocated care. One of the secrets of saving money that Moore did not go in to is that by providing the best possible care, health care costs go down. This has been proven over and over again in countless studies, and why there is such a big push in the health care - and insurance industry to adopt Evidence Based Medicine Practices and integrate IT. Insurance companies were willing to pay me good money as a consultant and as an in-house nurse to advise them on the best possible plan of care for their insureds.

I only bring up the issue of race because it was brought up in the film: When a black worker for a utility company suffered a catastrophic spinal cord injury in an industrial accident, the Director of the large Worker's Compensation insurer company repeatedly instructed me to make sure Mr. S. had the best possible care. I was given complete latitude to find the best doctors, therapists, transportation companies, surgeons to provide his care. I was to spare no expense coordinating getting a car that he could drive outfitted for him, or accommodations made to his home. Both he and his wife knew they could call me and talk about any problems they were having and any issues they were dissatisfied with and I would do everything in my power to make it right. The doctors, therapists, injured worker and his family and the insurance company were all happy with my work for them. That is what I strove for every day - to create a win-win for everyone.

Because I am bilingual in Spanish, I am often called in to coordinate care for monolingual Spanish speaking (often illegal immigrants) from Mexico and Central America who were injured on the job. Before any of you go freaking out about illegals, let me tell you that the patrons, or bosses, go down to these countries seeking cheap labor and bring them back to this country. Oh, yes. I know a lot. They go down and recruit young men with second or third grade educations who are functionally illiterate. They bring them up here to the US and put them in high risk jobs. They get injured. Duh. Our great health care system puts them back together again. Our Workers Compensation pays for it. I'd love to tell you about Mr. J. -put back together again by the Stanford Trauma team- but there is just too much to tell. It's another blog posting. Let's just say Mr. J got the best of care and a new Cadillac Escalade. And he deserved every bit of it. He lost so much. More on that story later.

Michael Moore's movie would have a lot more impact if he narrowed his focus. If he had focused on the Kaiser Permanente story from Nixon to patient dumping, to the little girl who died. Or if he had focused on the 9/11 heroes from the time they volunteered through their treatment in Cuba. His story gets diluted when he throws everything into the pot. His story seems a bit strident when he tells only the side he wants to tell. See Barbarian Invasions
for another take on the Canadian healthcare system. Interview some nurses who have fled the NHS system in the UK. Unlike the doctor who lives in a million dollar home, they claim to be underpaid. Or go to Nepal and fracture your ankle while hiking in the mountains. See what you think of that healthcare system. If you don't want to travel so far, go to Mexico. And someone please get him a good editor! Michael - if you want a great follow-up story, someone should do a documentary on Michael Ruppert. Here is a case where lack of health insurance truly trumped First Amendment Rights!

Speaking of Mexico, I was blessed to receive great care from a Cuban doctor while on vacation in Tulum a few years ago. My daughter had an asthma attack and the doctor came to our hotel room/cabana, delivered medications and a nebulizer machine and gave her a steroid injection. Total cost of care? $15.


Photo courtesy of Google Images.

Labels: health care, insurance, Michael Moore, Sicko, Workers compensation

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