Medicare and Disablism

May 1st is Blogging Against Disablism Day.  As Dairy of a Goldfish explains: "This is the day where all around the world, disabled and non-disabled people will blog about their experiences, observations and thoughts about disability discrimination. In this way, we hope to raise awareness of inequality, promote equality and celebrate the progress we've made."

I have good news and the bad news.  The good news is that some of the biggest things we can do to vastly improve the lives of the disabled within our health care system can be done largely without a fight.  They're largely in the hands of the federal government.  The bad news is they're largely in the hands of the federal government.  If we’ve learned anything, it’s the inherent disablism in our political system, particularly in reforming Medicare.

Not that I think such disablism is intentional.  The sins appear to be of omission, not commission.  Although Medicaid has always mandated treating the disabled (and today pays for about half of the money for long-term care in this country), Medicare only added that eligibility in 1972.  That appears to have been the last time the political establishment really looked at whether these government programs are truly providing not just high-quality care, but the most cost-efficient and the best for the patient.  We live in a vastly different world, one where there are more options for care for disabled Americans, yet one that still operates on a default presumption of institutionalization, like it was the Ford Administration.  Over 6 million Americans qualify for the Social Security Disability Insurance Program and have their needs for long term care covered by Medicare, Medicaid or both.  That means we don’t have to fight with insurance companies or ideology or tea baggers or any of that other nonsense.  We just need to commit to solving the problem, making the lives of millions of disabled better and, in most cases, save our system money in the long term.

That starts with ending the two-year waiting period for Medicare benefits for the disabled.

Talk about your relics from the past.  A report from The Commonwealth Fund from 2002 estimated that 1.2 million SSDI-qualified individuals were in the peculiar two-year waiting period before they could access disability benefits through Medicare.  These are people who have qualified by paying their Social Security taxes and working their quarters, following the rules of the system.  Half of them are already on Medicaid.  About 1/3 of them are uninsured.  Yet Medicare makes them wait two more years.

From the get-go in 1972, this waiting period’s main rationale was “to keep costs within reasonable bounds” – for the government, not for the person who now must adapt his or her life to their needs.  Also from the get-go, an exception was written into the law for renal failure.  In 2000, another exception was made for Lou Gehrig’s disease.  That's it -- but that only begins to scratch the surface of those disabled Americans who rely on Medicare for long-term care once they've waited out the delay.  According to the Social Security Administration's stats, "Thirty-six percent had a mental disorder as their primary diagnosis, 21 percent had diseases of the musculoskeletal system
and connective tissue, 10 percent had circulatory  system diseases, and 10 percent had diseases of the nervous system and sense organs."

So some long-term disabilities are OK to exempt from cost-cutting but some are not?  The hell?

Commonwealth Fund’s report is also instructive – if the two-year waiting period were eliminated entirely, Medicare’s costs would increase a miniscule 3.4% per year.  But that wouldn’t translate entirely to new money paid by the government, because half of those citizens are already covered by Medicaid.

Long story short:  the cost savings for the government are tiny.  The cost savings for the disabled in that two-year window are huge.  We need to change this now.