How Will COVID19 Impact Employer Health Insurance in the US?


Covered California released the first national projection of how the COVID-19 pandemic will affect employer health insurance. The report predicts that employer premiums will rise in 2021 by 40 percent or more, absent federal action, which is certain to alarm many employers. 

As the former CEO of Blue Cross & Blue Shield of Rhode Island, I disagree with these ominous projections, and believe that in the wake of COVID-19, any rise in health premiums will be minimal, one-time events (which I explain below). 

Moreover, I believe it’s time for employers to consider a more important question: whether they should pass any future rate increases to employees, which for years has become a common practice with profound ramifications for both employee well-being and employers’ bottom lines. 

As a former healthcare CEO, I’ve taken part in the complexities of health insurance ratings for years. To better understand how the COVID-19 crisis might impact insurance premiums, I consulted with insurance actuaries about changes that may arise in the coming year.

Overall, I believe that COVID-19 will significantly increase claims expenses in line with Covered California’s projections, which will include higher ER intake and ICU overflows, and increased hospital staffing.  

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A Revolutionary Old Vaccine For Physician Burnout


Burnout has become an obsession in the medical profession.  I am almost 75 years old and am not feeling any of the symptoms of physician burnout.  I do not state this out of any sense of pride, but I have tried to be introspective about this to offer some advice as to how to avoid this problem.

My approach is fourfold.  I shall begin by reviewing the definition of burnout, emphasizing physician burnout.   To address the individual issues, I think it is important that we are all on the same wavelength and are using the same definitions.  Secondly, I will review some facts about the reality of American medicine as we now experience it.  Third, I shall articulate a paradox between what seems to be an epidemic of physician burnout in the context of the reality of American medicine.  Finally, I will offer a nine-point set of suggestions, which are meant to help to avoid the symptoms and signs of this syndrome.  

 Burnout is not a new idea, and it is not specific to medicine.  It has been in the psychiatry literature for quite a long time, but it was brought to our attention in medicine in a series of papers by Zeev Neuwirth, who, at the time, was an internist at the Lennox Hill Hospital in New York.  He wrote several papers on related subjects and published an article in the lay press in 1999 that was entitled “The Silent Anguish of the Healers.”  Since that time, it has become evident that “burnout” is an important issue in medicine that needs to be addressed.  Neuwirth and others have defined ”burnout” as a feeling of complete emotional exhaustion characterized by cynicism, depersonalization and perceived ineffectiveness.

An Epidemic of Dissatisfaction

In recent years, many have argued that “burnout” is extremely prevalent; not only in society in general but especially in medicine.  It has been said that 50% of physicians have at least one of the three cardinal features:  exhaustion, depersonalization and inefficacy.  The problem with these kinds of data is that are no adequate controls; especially controls from others in the learned professions.  It is probably quite common for many people, at some point or another, to experience one or more of these cardinal features.  The real question is whether this is more prevalent than in a control population and whether they are persistent, rather than transient, symptoms.  That information is not available.  For these reasons, it is likely that the problem of “burnout” is being exaggerated.  Nonetheless the problem undoubtedly does exist in an unknown proportion of physicians.

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One of the Vulnerable


I will be 79 next month. What do I think? I think the country should open back up, albeit cautiously. I’m embarrassed to think that people have to up-end their lives for older people like me. For one thing I’ve lived a hell of a life.I’ve been around the world, I’ve been a mom, a foster mom, and a grandmother, and an entrepreneur besides. I have written a few crummy books.

As one of the vulnerable, I’ve been stuck in the house now for six weeks, learning every detail about the Coronavirus. I have seen only about half a dozen people who are part of my quarantine barrier: people with whom I walk my dogs outside in the morning, my roommate, my barista and the woman who sanitizes my home once a week. And that group is considered too risky for most, but I’ve always been a risk taker and I’ve known my housekeeper for 25 years. I know she will do her best not to cause my death.

What do I do all day? Mostly I exercise, walking or taking Zoom yoga. What do I wish I could do? Hang at the bar at Hillstone. When will I be able to do it? Safely, probably not for two years.

Right now Arizona is on lockdown but we are preparing to re open soon. Our case numbers are not declining although the increase has slowed. We are part of the wild west, and our social distancing is not as strict as California’s, or my daughter’s in London. For example, I took a walk along the canal near the Arizona Biltmore hotel on Sunday and there were couples laying in the grass near the putting green of the golf course. They were drinking mai tais and beers and reinterpreting social distancing in their own ways.

They were young and I’m sure they didn’t perceive themselves as vulnerable. There were also more than 10 of them and they were oblivious to the numbers. I was jealous. I don’t want to be one of the vulnerable. I wanted to join them and have fun.

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