I attended a regular safety meeting with one of my clients this week. This county has one of the most comprehensive programs of all my clients, big and small. The safety director handling the meeting distributed a piece of paper that made me wonder why it should only apply to property and casualty. It was titled, "The 5 Whys - Root Cause Determination." The purpose of the procedure was to do what children discover at a very early age, keep asking "why" until the parent gives in. In this case it was to keep asking why until you arrived at the root cause of the accident and ultimately an expense to the employer and everyone else participating in the program.

So why can't an employer keep asking why until the employee gives the real reason for their over utilization of the health care benefit plan? Why can't we use the same system to lower the cost of healthcare? This, I think, is a very good question.

So why does a particular covered employee or dependent use coverage inappropriately? More importantly, why do they get to continue to keep using it when they violate simple principles that would otherwise eliminate their need for coverage? Again, a great question. How am I doing on drilling down on the "why" thing?

If an employee, in Tennessee, covered by an OJI or On The Job Injury Plan (a public entity can opt out of workers compensation in Tennessee) hurts their eye because they refused to wear protective eye wear, the employer can deny the claim. However, if an employee is overweight, has high blood pressure, high cholesterol, smokes, or just generally abuses their body and refuses to change their ways, they get to keep going to a doctor and having surgery to correct their abusive lifestyle. Why is that?

In the case of workers compensation it goes back to labor. Benefits have been at the heart of union negotiations for decades and are considered entitlements. Nothing was ever negotiated concerning personal responsibility to maintain those benefits. In some cases the employees, or even owners of companies, who make recommendations about plan changes are themselves abusive in their health lifestyles and don't want to make changes.

Up until recently it was just a matter of being able to afford it and cost shifting. Today the costs are just too high and there is nothing left to shift. It is time to answer the question; why.