From the New Republic (9/14/09):
The Truth About Disabilities and Health Reform
by Harold Pollack
[Lisa] Iezzoni, MD is Professor of Medicine at Harvard Medical School and Director of the Institute for Health Policy. Among her areas of expertise is “risk adjustment”--an arcane-sounding term which basically entails looking at how much it costs to take care of people in different states of health, and then adjusting payments (to doctors, to hospital, to insurers) based on that.
But it’s her personal expertise that makes her particularly well-suited to talk about health care and disabilities. She is not only a doctor; she’s also a wheelchair user. A book she co-authored, More Than Ramps, provides policymakers and clinicians with nuts-and-bolts advice about how to improve health care quality and access for people with disabilities...
Pollack: Let’s shift to the surveys you've conducted with women and men, mostly women, diagnosed with multiple sclerosis. More than 90 percent actually had health insurance.
Iezzoni: Yes. 96 percent had some form of health insurance. People with MS have two things going for them. Number one, many were formally employed, and so they have paid into the Medicare trust fund sufficiently to get SSDI. MS is one of those list conditions. So--assuming there's a medical record and documentation is up to stuff--people with MS typically do get SSDI. Second, people with MS have a fairly high rate of being married. So they can get spousal health insurance if their spouse is working.
If you dig a little bit deeper under our results, about a quarter of our insured respondents still were splitting pills, delaying medical care, feeling like they didn't enough money for basic necessities because of medical care. It’s the old issue of underinsurance. It really is an undercurrent for this population, especially where some of the drugs can cost upwards of $20,000 or $30,000 a year.
Pollack: The leading bills moving through Congress repeal lifetime caps and include related provisions. Would these ensure that people would be liberated from these kinds of anxieties?
Iezzoni: I think that the very first thing that removes anxiety from people is the prohibition against denial based on your health status. That is just a terrifying thing. I'm a professor of medicine at Harvard Medical School. I am afraid that if I lose my job I will lose my health insurance because nobody would ever insure me again. And for somebody like me to feel that way, think of how other people who do not have the connections I have must feel...
...Pollack: Your last comments point out either the irony or the grotesqueness in the current public debate, in which critics of health reform are attempting to argue that the elderly and the disabled who would be the most disadvantaged by this legislation. Many of the 615 pages that we've discussed are provisions that are intended to provide new services or improved services to these very populations.
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