Our health care insurance infrastructure is being dismantled, and it comes at a critical time. Spinal cord injury and traumatic brain injury rehab centers have been under attack for years, with less and less rehab time covered by Medicare and private insurance companies. Now the new administration seems likely to make the problem worse by cutting funding. Having adequate rehab time is critical to regaining independence, but being outright denied rehab can be catastrophic.
My nephew Nick, father of four, sustained a severe TBI in April of 2014. He regained consciousness in a Santa Maria, California, hospital four weeks later. I advocated for him to be transferred to Santa Clara Valley Medical Center in San Jose, California, a TBI and SCI rehabilitation center, part of our nation’s Model Systems network supported by the National Institute of Disability Research and Rehabilitation. Our best rehab centers are part of this national network. His HMO denied the request and sent him instead to a long-term care hospital in Los Angeles — a remodeled nursing home. At 46, he was the youngest person there, the only one with a TBI.
Over the next 18 months he was transferred 12 times to various facilities in the state. He never received the full-time specialty care that a severe TBI demands if the person is to have a chance of regaining full speech and movement. He showed signs of improvement, including intermittent talking and moving of limbs, but never enough to avoid the next transfer to a different facility, dictated not by his doctors, but by his HMO’s need to cut costs. Each time he was moved, his new facility gave him less, not more of what he needed.
One of the last places he was in — another nursing home — was shut down due to health care violations literally moments after he was transferred from there. He died in a hospital in late 2015, never making it to a TBI rehab center.
His HMO network had refused to work with the family to transfer him to one of a handful of specialized TBI rehab centers in the state. Nick was a surveyor. His HMO was provided by his employer, the state of California. If this is not proof of failure of our health care system, I don’t know what is. But the larger tragedy is his story is not unique.
Our health care system is failing many who deserve a chance to recover from severe injuries — SCI as well as TBI — by allowing insurance companies to call the shots when expert, specialized health care is needed. Insurance companies are not qualified to make these decisions. Their primary concern, profit, works in direct opposition to providing the expert medical care that severely injured people need in order to survive and prosper.
Sadly, neglect of severe TBI and SCI survivors is just the tip of the iceberg. We now have a president who seems bent upon decreasing the availability of affordable health care insurance while simultaneously cutting funding for rehab and research. This is a tragically flawed approach to health care that must be reversed.