The Missing 20%

According to data we have seen, the “disabled” (or PWDs) account for a full 5% (or one third) more of the Medicaid (or government healthcare benefit) recipients in North Carolina than the “elderly” (those over 65). The former are about 15% of recipients, the latter only 10%. We are going to extrapolate this data as a roughly equivalent “national” average even if the numbers in other states are higher or slightly different.

However, in light of just this fact, it boggles the mind that the most frequently cited users of government health benefits are “the elderly.” This is in fact how so much of the current budget debates and fights over “Medicare” or “Medicaid” are framed.

The reality is that the people most affected, for the longest period of their lives by both government benefits and “Medicare” (which is essentially the same as “Disability”) are in fact completely left out of the debate if not invisible. That’s a pretty big exclusion. National figures of PWDs put this population statistically at 20% of the country. About twice as large, we add, as the African-American or LGBT population and certainly one, across all age demographics, that will compete with the Boomers in terms of size if not wealth or relative health.

These are also people that, in fact, the Boomers have systematically ignored for the last 20 years since the passage of the ADA.

As both populations reflected in the data sets are relatively “stable” (in other words, most people over 65 receive Medicare and unfortunately most PWDs under 65 are still kept out of the job market, so this figure is also fairly reflective of overall PWD numbers), these two figures are a fairly reliable indicator of the total size of the population itself and “steady-state” recipients (in other words people who are not likely to move off the roles without significant policy in place to address it). The reason why PWDs have such an appallingly high rate of poverty if not unemployment (90%) is an issue we won’t discuss here, but we want to put our stake in the ground as recognizing it.

However more to the point, PWDs are also the largest “consumer” of government benefits of all those that receive them. Over 40% of the money spent on government healthcare in-state flows to this population. To put this in comparison, the “elderly” only account for about 26%.

This means a couple of things. It means that current efforts to “reform” the system, whatever it is called, must be systematic.

It also means that nobody is going to really affect the budget all that much if the debate only focuses on the recipients of government health benefits over 65. No matter how big and bad the Boomers like to think they are. Specifically, “vouchering” care is a drop in the bucket to the real, ongoing needs of a large segment of the population which statistically also uses such benefits, conceivably, for most of their lives – not just post-retirement.

For the uninitiated, this could seem like one of those “kick the can down the road” discussions. Unfortunately, anyone concerned about the budget these days (and let’s face it, we all are) needs to understand how imperative real reform is. It literally affects the Constitutionally defined “worth” if not “contractually defined value” of many human beings in this country. We’ll skip the wonky discussion of the implications of the 1991 Civil Rights Act in this blog post and how it intersects with the ADA, but we’ll come back to it later. The reality is that government healthcare benefits, particularly for PWDs are in fact part of such individuals’ implied contractual rights with the state if not tie into the perceived “worth” of a PWD per the Constitution.

Starting with, we argue, allowing as many of those currently on “Disability” to have every opportunity, including training, education and structural access to employment (if not real prosecution of their rights under the ADA) so that America may finally address its last great discrimination story. Not to mention start to address budget cuts in a real way and “right” the structural problems with the economy. Nothing close to this mindset exists right now in the official halls of power. One of the many reasons we decided to start this company (apart from the business case that exists) is to also bring attention to the unbelievably horrific realities of most of this population – suffering that is absolutely unnecessary if not immoral.

The reality also is that the many problems of “Medicaid/Medicare” actually work in concert to also rob PWDs of the ability to work, simply because the system is so beyond awful at the moment that it usually takes a significant amount of time to get care – so much so that it could easily impinge on the ability to find and keep employment (of any sort.)

The hidden story of the “missing 20%” in current budget discussions is also one we are working to highlight simply because it is also another “fix” that we support. It’s a far more complicated one to address, however, from the policy level, particularly in such a highly-charged debate where brinksmanship and lack of details about goals seems to be more important than focusing on the underlying issues required to create real change.

For those used to Washington politics, the response to this assertion may very well be “what’s new?”

In such a cynical and jaded echo chamber, we do actually think we do have something new.

We also think however, particularly for an administration that promised “change we can believe in,” that this is a very good place to start listening.

Disingenuous “Budget Cuts” For “Medicare”

We, like just about anyone alive with access to media (old, new or somewhere in between) know that the hunt is now on for savings. And as usual, everyone is looking to “Medicare.”

We do feel we need to weigh in on this issue at the moment from what we hope is a strictly non-partisan “green” stance, however it is apparent to us that despite all the rhetoric, as usual, to date, there is more hot air than substance on all sides. We would say gas, but, well, we think savvy readers get the point and we wouldn’t want to get into any confusion about “good” gas and “bad.” We run into that problem enough as it is.

However, the reality is, beyond Beltway Contortions, is that “Medicare” actually refers to all government-sponsored health insurance. While the VA (this time) is apparently being saved from all consideration, in general, VA covered medical care is the same thing as HHS covered “Medicare” – as are “Disability benefits” and of course “Medicaid.” When it comes to healthcare, the benefits are all the same. We won’t confuse the uninitiated with a further discussion of the “dually eligible.” So many monikers, all the same deal.

This means, however, for example, that doctors are compensated under the same rate, and, to get to a point, so are drivers. Even more to the point, according to some interesting figures we have seen, historically, “the disabled” or as we refer to them, “PWDs” have actually been a higher driver of care costs than the “elderly.” (We refer to those folks these days as, um, “Boomers” however much we know they really hate that. No matter how cute Robert Redford looked on the cover of AARP’s national mag not too long ago.)

Snarking aside, that’s an awfully big segment of the population that is being rather systematically ignored. Annually, not just cumulatively.

Oops.

What this also means of course is that the current calculations of “getting rid” of Medicare if not “voucherizing” it essentially means that people who have had “Medicare” all of their lives or after a disabling situation or illness, will be essentially cut off after they reach 62. Sort of like a “Logan’s Run” on the far, far, side of 30.

We won’t even begin to think of weighing in on that score, however we did think it was appropriate to bring up a topic that is directly at our core mission and one which is directly related to that problem we just mentioned. Specifically, added to this very grim situation already is that there is a great deal of transportation now (supposedly) reimbursed by HHS.

We say “supposedly” because that is really what it means. And while we don’t want to get into any Title II discussions (for one) we believe that many areas are actually in danger of (unintentionally) violating Title II of the ADA with “budget” but not civil rights law compliant service cutbacks that affect the (unfortunately still too high) 90% of the 20% of the country with a disability who is also forced, for whatever reason, to also receive government benefits (known broadly as “disability”).

That’s where we hope we can really make our first impact. We also hope that we begin to make enough “noise” on the policy level (and we don’t care where, how, or with whom, as long as we can make our point) that draining the petroleum out of Medicaid (the blanket default medical insurance program we should probably all get used to referring to) is one of the best ways to immediately figure out ways to “cut it” while planning longer term service models (like ours we not so modestly suggest) to actually make the service itself if not the transportation that serves this community, the most efficient, best and cost-effective it can be.

After all, Title II of the ADA was designed as the “no separate but unequal” clause of the statute. In “Title VII” terms (which also apply here we hasten to remind any legislators reading this), this is essentially the “no white drinking fountain” clause of the ADA.

We think this makes the point without, say, sitting in any cafeterias marked “able-bodied only” and most certainly without posting a cartoon somewhere effective with two (non ADA compliant) drinking fountains – one for the “able-bodied” and the other for “gimps.”