Bully Pulpit: The Numbers Game


We are on a collision course. Two opposing forces are gathering momentum like waves headed in opposite directions, and when they meet head on, chaos and confusion will prevail.

We are in an era of unprecedented medical innovation. More and more medical breakthroughs are coming into play or on the drawing board. At the cellular level, such as with stem cell implants and manipulation of brain and spinal cord resiliency (plasticity), we are seeing a growing body of successes in treating diseases and conditions that were previously considered untreatable. And at the product level, such as with exoskeletons or epidural stimulation devices — whether implanted or transcutaneous — the future holds more promise than ever before.

But an opposing force driven by a wave of economic uncertainty has been with us for a long time and is growing at an especially alarming rate. Individual states have had serious budget problems for years, but the federal funding impasse may now be even more critical. This negative wave affects NEW MOBILITY readers in at least two major ways. First, newer processes and products, no matter how beneficial they may be, are harder to finance and bring to market. Second, coverage approval from Medicare, Medicaid and private insurers is getting tighter.

Is there an answer? I’m no economic expert, but I have to believe that tax reform that frees up more tax revenue from the wealthiest corporations and individuals will go a long way toward meeting our ongoing medical needs, as will larger insurance groups, but only if legislators make it happen. Crowdfunding, however limited, is a bright spot.

But it’s the health care delivery system that has me really worried.

Anyone with experience in dealing with private insurance companies knows that we are already caught up in an unacknowledged triage system. The medical insurance industry professes to be in the business of caring for people’s health, but we all know that in reality they are all about spending as little as possible, and doctors’ expertise can be undermined in the process. It’s always about the bottom line. This system works great for two groups of people — those who have the most money to spend on the best insurance coverage, or those who are fortunate to work for a large company that can afford to provide their workers with the best coverage. Everyone else has to do with less, and in some cases, that means untreated medical conditions, and even death.

The federal dollar crunch affects the Centers for Medicare and Medicaid Services in a different, yet similar way. Basic Medicare coverage (most affordable) keeps shrinking, while expanded Medicare Advantage plans (most costly) deliver the best care. State Medicaid programs can be stingier than Medicare. Once again, it’s about the bottom line more than our health needs.

What can we do? We must speak up for our health needs. We must join with allies. It’s all about numbers. To fight the negative effects of the bottom line model, we need more of everything — more people, more voices, more influence with legislators and the media.


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