Not Cease from Exploration

Thursday, May 2, 2013

Firefighter Cancer Presumption Act of 2011: Noble Idea, Bad Policy

A scenario for you:  A firefighter, after a long career, develops lung cancer.  He was also a pack-a-day smoker for 30+ years.  What caused the cancer?

Well according to the Commonwealth of Pennsylvania (legislators & a governor, not doctors), it was his firefighting duties and not his smoking the caused the cancer.

Now let's make it even more complex:  assume that the firefighter in question, by virtue of his role (as a captain, driver, etc.) spent less time than his peers in burning buildings AND none of his peers developed lung cancer.  Again, what caused the cancer?

Again, according to the Commonwealth of Pennsylvania...legislators and a governor, not doctors...it was his firefighting duties and not the smoking that caused his cancer.

By "according to the Commonwealth of Pennsylvania" I specifically refer to a law known as the "Firefighter Cancer Presumption Act, Act 46 of 2011".

You can read a Scranton Times article on this subject HERE.

You can also read a "pro-firefighter" report on this legislation HERE.

From the Scranton Times article:

"Dubbed the Firefighters Cancer Presumption Act, Act 46 of 2011 recognizes every form of cancer found in a firefighter as a work-related illness. The onus to prove otherwise is on the municipality. Before the law, a claim could be filed going back 300 weeks. The law doubled that to 600 weeks."

Note the term:  "...every form of cancer found in a firefighter as a work-related illness".

By the way, 600 weeks is equivalent to over 11 years.

For insurance carriers providing coverage for firefighters, this creates an almost impossible situation.  Why?  Well because insurance companies are in the business of understanding and managing risk.  Knowing what is a cause and what is an effect enables insurance companies to model how much to charge for insurance coverage. If they can't model the underlying risk, then it becomes virtually impossible for them to provide the coverage.  The Firefighter Cancer Presumption Act does just that though:  it makes it virtually impossible for an insurance company to provide this coverage because it says that ALL CANCERS in firefighters are work-related.  The net result?  Insurance companies are dropping coverage for paid and volunteer fire departments.

Now to put this in context, just what are the odds of getting cancer anyway?  Well according the website www.cancer.org they are as follows (citation & credit HERE) for all Americans:

Males

Risk of developing
Risk of dying from
%
1 in
%
1 in
All invasive sites
44.81
2
23.08
4
Bladder (includes in situ)
3.81
26
0.88
114
Brain and nervous system
0.70
143
0.50
200
Breast
0.13
769
0.03
3,333
Colon and rectum
5.17
19
2.11
47
Esophagus
0.81
123
0.78
128
Hodgkin disease
0.25
400
0.04
2,500
Kidney and renal pelvis
2.04
49
0.61
164
Larynx (voice box)
0.60
167
0.21
476
Leukemia
1.59
63
1.02
98
Liver and bile duct
1.18
85
0.83
120
Lung and bronchus
7.77
13
6.74
15
Melanoma of the skin
2.49
40
0.42
238
Multiple myeloma
0.77
130
0.46
217
Non-Hodgkin lymphoma
2.34
43
0.88
114
Oral cavity and pharynx
1.50
67
0.38
263
Pancreas
1.48
68
1.32
76
Prostate
16.15
6
2.75
36
Stomach
1.09
92
0.51
196
Testicles
0.37
270
0.02
5,000
Thyroid
0.52
192
0.05
2,000

Females

Risk of developing
    Risk of dying from
%
1 in
%
1 in
All invasive sites
38.17
3
19.39
5
    Bladder (includes in situ)
    1.15
    87
    0.34
    294
    Brain and nervous system
    0.55
    182
    0.40
    250
    Breast
    12.38
    8
    2.76
    36
    Cervix
    0.68
    147
    0.23
    435
    Colon and rectum
    4.78
    21
    1.94
    52
    Esophagus
    0.23
    435
    0.21
    476
    Hodgkin disease
    0.21
    476
    0.04
    2,500
    Kidney and renal pelvis
    1.20
    83
    0.34
    294
    Larynx (voice box)
    0.14
    714
    0.05
    2,000
    Leukemia
    1.14
    88
    0.71
    141
    Liver and bile duct
    0.49
    204
    0.43
    233
    Lung and bronchus
    6.35
    16
    5.02
    20
    Melanoma of the skin
    1.58
    63
    0.21
    476
    Multiple myeloma
    0.57
    175
    0.37
    270
    Non-Hodgkin lymphoma
    1.93
    52
    0.71
    141
    Oral cavity and pharynx
    0.68
    147
    0.18
    556
    Ovary
    1.38
    72
    1.00
    100
    Pancreas
    1.45
    69
    1.30
    77
    Stomach
    0.66
    152
    0.34
    294
    Thyroid
    1.53
    65
    0.07
    1,429
    Uterine corpus
    2.64
    38
    0.54
    185


Sadly, Americans have a high chance of getting cancer regardless of occupation.

For the record the law creates a way around the "all cancer caused by firefighting" dilemma:  the firefighter's municipality can conduct a (no doubt wildly unpopular) investigation in order to prove that the cancer in our scenario above was due to the firefighters's smoking habit, but the presumption of facts is in favor of the firefighter...as long as they file the claim within the 600 week window.  The law seems designed to basically prevent municipalities from challenging these designations.

Let's examine this from another perspective:  Is firefighting such a dangerous job that it should be entailed to a presumption of cancer always being work-caused?  Well according the Bureau of Labor Statistics, firefighting is NOT the most dangerous job in America.  Actually it is not even in the top 5 of most dangerous jobs in America.  Here's the list, based on work-related deaths per 100,000 workers (for 2011):


  1. Fisherman (121.2)
  2. Loggers (102.4)
  3. Pilots (57.0)
  4. Farmers and Ranchers (25.3)
  5. Police Officers (18.6)
  6. Construction Workers (15.7)
  7. National Average (3.5)
  8. Firefighters (2.5)
  9. Cashiers (1.6)
  10. Office Admin (0.6)
  11. Business and Finance Staff (0.5)

Reference HERE.  Remember, this law now says that "if you are a firefighter and you have cancer, it is work related", so adding cancer deaths to the above might bump firefighters up on the list.  But why single out firefighters for this special treatment?  I'm not sure, other than the legislation in question is more about appealing to emotions than it is an actual policy remedy.  You could argue that there are greater exposures to carcinogens in firefighting, but what of it?  A tragic work-related death is a tragic death; anyone want to argue that which of the following is more tragic?

a) A firefighter who dies from lung cancer
b) A police officer who dies from bile duct cancer

Remember, the law presumes that the firefighter's cancer was caused by his occupation.  How do we know though that the stress of being a police officer doesn't contribute to bile duct cancer?  Or what if a police officer spent most of their career in the traffic division, being exposed to almost constant exhaust pollution?  Note that police officers have almost ten times the death risk of firefighters anyway, so where is their special treatment?  The whole notion behind this legislation seems misplaced.  If anything, the government should make sure that all firefighters...paid and volunteer... (and all public safety professionals for that matter) are always afforded the best available equipment needed to prevent injury and death.  Buying breathing equipment may not be as "feel good" as the Firefighter Cancer Presumption Act, it seems to me to be far practical allocation of societal resources.

Bottom Line
The Firefighter Cancer Presumption Act isn't about "evil insurance companies denying coverage to heroes"...it's about a noble idea, namely that we need to meet the valid work-injury needs of public servants, that has run amok.  This is bad policy, plain and simple, designed by a legislature that is more interested in how things appear than how they will actually work.  It is an illogical leap made by a government officials who are skilled in defying logic.  This is a solution that is wildly in search of a problem.

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Note:  I work for a large insurance company, although to the very best of my knowledge my employer does not provide this kind of coverage.

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