“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well-preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming ‘Wow! What a Ride!’”
—Hunter S. Thompson
I have accomplished the part about being used up and totally worn out, but I am not yet ready to skid in -- broadside or otherwise. Instead, I would like to stay healthy so I can enjoy what life is left, but need some help doing so.
Diminishing access to, and the increasing costs of, quality healthcare for people with chronic disabilities has become a huge problem in this country. Private insurers are charged exorbitant amounts by hospitals and other providers, because those providers are seeking to make up for the extremely low payments they receive for the same services when providing them under Medicare
. Those low payments are due to congressional limits placed on what providers are able to charge under those federal programs. I experience that every few months, as the company that provides my medical supplies recently billed Medicare about $360 and ended up getting paid only $155. Not only that, but several critical items are now routinely denied, requiring me to pay for them "out of pocket."
A recent Time magazine article
pointed out that providers have reacted to these arbitrary low levels of reimbursement by inflating their charges far beyond the actual costs involved. The result? A simple procedure might result in a bill from one hospital that is 10 times higher than what another hospital would charge. Costs of healthcare can equal or surpass the total of all other items that consume a paycheck of a person with a significant disability. The only item that exceeds healthcare costs in my monthly budget is my home mortgage.
It is likely that increasingly high costs of healthcare will mean that even more people with disabilities will forgo employment in favor of having Medicare or Medicaid pay their health-related costs. Who can blame them, especially when it takes a supreme effort to get hired and then to get to work each day? If they are currently enrolled in the other available unemployment programs such as SSDI
, subsidized housing and personal assistance services, it would require a very high salary to earn enough money to equal the value of the benefits that can be received while remaining unemployed.
Those of us on Medicare and Medicaid are slightly better off when it comes to the direct costs of healthcare but are likely to be limited when it comes to our access to services, equipment and supplies: all thanks to restrictive policies put in place by the Centers for Medicare and Medicaid Services (CMS).
One example of that is the requirement that any rehabilitation-related service must result in improvement, not just maintenance, of function, which precludes many people with chronic disabilities from getting necessary therapy. The result can be long-term loss of function and the potential of deteriorating health.
Another problem is the CMS competitive bidding process for durable medical equipment distributors. This policy has put many small businesses out
of business and in some regions has even made it difficult or impossible to access such vendors for the purchase or repairs of our equipment. A company that has the contract for the provision of a particular device in a region may be unable to provide repair services if there is a problem with the equipment. The announcement that CMS will be expanding the competitive purchase program to additional states in the coming year will assure more confusion and problems for people with disabilities across the country. Unfortunately, thanks to debacles like recent exposure of The Scooter Store's fleecing
of Medicare, such events will be used by CMS to argue that their restrictive policies are absolutely necessary.
There are many organizations and individuals in Washington, DC who are concerned about the new CMS restrictions. Some members of Congress have spoken out against the policy, and most disability advocacy organizations have rallied their members to educate Congress about the need to pass legislation that would keep CMS from implementing such policies. One of these organizations has the firepower to make a huge impact with their educational effort.
With over 450 member Centers for Independent Living
representing people with all types of disabilities, the National Council on Independent Living (NCIL)
is coordinating disability advocates and organizations nationwide in efforts to get legislation passed that would change the regressive policies already in place or stop the expansion of the program that is under consideration. I would encourage everyone to join their efforts to bring about improvement. To begin, check out their website
to view the fact sheets about this issue.
Since our nation is paying for healthcare one way or another, we should at least strive to assure that the policies in place keep us healthy. Failure to do that will assure that even higher costs lie ahead, and might restrict my ability to "skid in broadside in a cloud of smoke"
as recommended by Hunter Thompson.
© 2013 Michael Collins