Friday, April 18, 2008

Medicare Is Newest "Black Hole"

In 2000 Congress met several times with an ALS patient that took on Medicare with the use of only two fingers. From the dark side of Lou Gehrig's disease, David Jayne had been granted "homebound" status by Medicare but broke the rules when he attended a football game. He was branded a Medicare criminal and his benefits recinded immediately. That's all it took for David to take on Medicare and so his solitary fight took shape. He founded, National Coalition to Amend the Homebound Restriction. This two fingered sports fan became the new Georgia Bulldog for ALS rights. David made week-long trips from his Atlanta home to Washington to lobby for legislation lifting restrictions that keep people who receive Medicare home nursing services from leaving their homes. Each trip to D.C. involved a mountain of detailed planning and scheduling by his family and friends. As with most ALS patients David couldn't speak, couldn't breathe on his own, couldn't feed himself and couldn't get on the toilet without help.
With the support of Sen. Bob Dole they pushed Congress just to take a look at the restrictions. Simple enough, you'd think? David felt that this experiment might flop when it was finally signed in 2004. He felt that Medicare simply could not handle the project. "If an adequate population sample is not achieved then Medicare will not be in favor. Congress gave Medicare the task to investigate the program in three states. Congress then authorized Medicare to enroll 15,000 in the study but their non-aggressive enrollment campaign only yielded 58 (stringent demonstration enrollment criteria kept enrollment low). Their conclusion following the two year study was written by Mathematica that stated, "Barriers to a successful experiment were difficult and policy issues remain. How lame can a federal agency get?
In my view stringing this one issue out for seven years is appalling. How much humiliation was a man near total paralysis supposed to endure. Heads should have rolled for the fact that a two year study proved no results, only that it did not work out. David had two working fingers, two eyes and with a friend, a football game could still be a blast.
Medicare has become a Black Hope that is going to suck the very existence away from ALS patients like David Jayne. President Bush has again offered dangerous policy prescriptions in his 2009 federal budget proposal that would further damage our broken health care system. This budget, if enacted, would undermine critical public health insurance programs and state budgets by cutting Medicare by $178 billion over the next five years and cutting Medicaid by $17.4 billion over five years. These heavy-handed program cuts and recycled ideas will cause further damage to our fragile health care system.
Maybe the Medicare Black Hole has a hidden message, if you got problems, "fin for yourself." For people with disabilities, finding quality attendant care can seem like a complicated maze, taking in a movie or a football game is just a few of life's simple options.
We need smarter solutions, and real reform.

To view Mathematica's full 140 page report (Black Hole) dated Oct. 2007


Anonymous said...

This appears to me to be a failed study rather than a failed concept.

I didn't see anything in there that indicates how much the taxpayers paid ABT and Mathematica to generate 140 pages of excuses as to why they failed to get sufficient participation.

Anonymous said...

Title: David Jayne Medicare Homebound Modernization Act of 2002

Summary: Amends the definition of "homebound" for purposes of determining Medicare eligibility for home health services. Prohibits the Secretary of Health and Human Services from disqualifying anyone confined to the home who has been certified as having a permanent condition that will not improve and that will require help to perform at least three of five daily living activities for the rest of the subject's natural life.

Sponsors: Sen. Susan Collins (R-Maine); Sen. Max Cleland (D-Ga.); Sen. Tim Hutchinson (R-Ark.); Sen. James Jeffords (I-Vt.); five others.

Status and Final action: Referred to the Committee on Finance for further consideration.