The Real Investment of Complex Rehab Technology


By Mark E. Smith

I strive not to overlap my print writing with my online writing because, really, there’s too much of my work floating around the literary world as it is. How much of me can any one reader take? However, I’m crossing my own boundaries and linking you to a very poignant piece in this month’s print edition of Mobility Management Magazine. You’ll learn a bit more about my life journey — and hopefully a bit more about others’ and your own.


Schooling Senator McCaskill


By Mark E. Smith

It’s always striking to me when people try to politicize wheelchairs and scooters – mobility aids, that is. After all, disability doesn’t discriminate – republican, democrat, or other, when you need a mobility aid, you simply need it. A mobility aid stems from a medical necessity, not a political preference – and ideology doesn’t get a vote in the process when you’ve lost the ability to walk independently.

For this reasons, it stunned me when I saw Missouri’s junior Senator, Claire McCaskill, say to Fox News’ Chris Wallace last week that “hundreds of billions of dollars” can be saved by simply not “giving free scooters to Medicare beneficiaries who don’t really need them.”

Her statements went beyond a political gaffe, and into the realm of spiteful, where Senator McCaskill went on national television and did nothing more than make outlandish, prejudice claims, politicizing mobility aids and scapegoating those with disabilities out of pure ignorance.

This wasn’t the first time, however, that Senator McCaskill went on the attack of mobility aids – and those of us who use them. See, in a May 27, 2009, town hall meeting, she noted that mobility aids and citizens with diabetes are taxing our health care system:

…This is the example I love to give. I did it on Charlie Thompson’s radio show this morning. Many of you heard it. And that is, how many of you have seen the ads for scooters? The ads for scooters. You can get a free scooter. Now think about that. It’s not a free scooter. Guess who’s paying for it? We’re paying for it. Now why do we have a system that is marketing and foisting upon many people that may not want ’em a scooter, ’cause it’s free? Well, it’s because we pay to get people scooters. Now, which is healthier? …Walking. So what are we doing? We’re paying for the scooters. …We’ve got to get back to rewarding good outcomes, we’ve got to get back to, and we can do this. We can lower these costs. Diabetes alone is an incredible drain on our tax dollars….

So, what Senator McCaskill directly suggests is that if you’re unable to walk due to disability like me, you’re a senior like my family member who barely gets by with a walker, or you have diabetes like my 12-year-old neighbor, you’re a lazy, “incredible drain” on the system.

As one with a disability, how do her words make you feel?

I’ll tell you in no uncertain terms how I feel about Senator McCaskill’s views: They make me feel like I’m hearing an elected official who’s so out of touch, and lacks such empathy for many of her own constituents – like adults with cerebral palsy, seniors with mobility impairments, and children with diabetes – that she’s not just from Capitol Hill, but void of reality.

All of this leads me to one critical question: What have those with severe disabilities, the elderly, and even children with diabetes done to cause Senator McCaskill to make us her scapegoat for the country’s fiscal crises and health care debate?

The answer is, those with disabilities have done absolutely nothing to be made Senator McCaskill’s target – and the statistics prove that point.

In 2007, Medicare spent approximately $1.2-billion on “power mobility aids,” out of total Medicare spending of $430-billion. Therefore, if Senator McCaskill had her wish and eliminated Medicare coverage of all power mobility aids, it would only save Medicare $1.2-billion out of its $430-billion expenses. Although, $1.2-billion is a lot of money, it’s actually only 0.28% of Medicare’s expenses – proving that Senator McCaskill’s claim that mobility products are taxing the system by “hundreds of billions of dollars” isn’t just exaggerated, it’s ludicrous.

Where the statistics become even more compelling is when one realizes that 67% of Medicare-funded power mobility aids go to the severely disabled, non-elderly – those with paralysis, muscular dystrophy, cerebral palsy, and multiple sclerosis, to name a few. Therefore, Senator McCaskill’s fiscal argument that eliminating scooter funding will save “hundreds of billions of dollars” becomes even more strikingly absurd, where scooters for the elderly are less than 1/3 of the $1.2-billion of power mobility funding. Scooters for the elderly, then, are “budget dust,” as Washington insiders call such small amounts, not a “hundreds of billions of dollars” end-all to health care funding as Senator McCaskill outrageously claims.

It’s also imperative to address Senator McCaskill’s statements that the elderly – and, anyone with a disability, really – get “free scooters” handed to them. Her statement demonstrates her absolute ignorance toward the diagnosis, prescription, and funding process. Scooters and power wheelchairs are FDA-regulated medical devices that must be prescribed, then authorized based on proven medical necessity, before Medicare will fund a mobility aid. Furthermore, in this era – where mobility funding has already been decreased by over 35% in the past five years, and the qualifications have become extremely stringent, including the in-home-use-only provision – it’s tougher than ever before for those with even the most clear-cut needs to obtain a mobility aid. In very simple terms, if you rely on a mobility aid, then you know that the process of getting one involves adjectives like frustrating, time-consuming, disheartening, unjust, and bureaucratic – and Senator McCaskill’s flip use of free isn’t in the equation, insulting those not only struggling to obtain a mobility aid, but also living with disability.

Now, since I’ve dispelled Senator McCaskill’s fiscal absurdities by simply presenting the facts, let me directly address her social concern that the elderly population is exploiting scooter use.

The social reality is, the elderly population isn’t racing out to get scooters as Senator McCaskill states. In fact, seniors who use scooters do so out of medical necessity – that is, they are limited in their ability to walk and require a mobility aid, accordingly. However, where the reality of scooter use among the elderly becomes especially poignant is that many elderly use scooters as a “last resort” due to declines in health, and some refuse to use a scooter even when unquestionably medically needed, as they see it as “giving in.” The elderly in America are a persevering, independent population, and they don’t turn to mobility aids until absolutely necessary.

In my own family, I have a 99-year-old relative who still lives in his own home, going shopping and such with assistance, and uses a walker. I’ve spent a great deal of time with him this summer, and it pains me to see him struggle with basic mobility, barely able to move about with his walker. Not only is he an ideal candidate for a scooter, but I actually got him one. Yet, he refuses to use the scooter, feeling as though it would be “giving up” – an understandable emotion for a man of lifelong physical strength and independence. As positive slants as I’ve put on scooter use in speaking with him – that it will make him more mobile and safer in everyday life – he refuses to use any device beyond his own legs, no matter how weak and limiting they are.

As my own relative demonstrates, contrary to Senator McCaskill’s ignorance, not only isn’t the elderly population exploiting scooter usage, many of age aren’t using mobility aids when they truly need them, so it’s entirely debatable that the elderly population is, in fact, under-served by mobility aids. Further, it can be argued that the under-served elderly population is actually a fiscal liability by not having mobility aids, a risk toward Medicare hospitalization costs. Again, I look at my elderly relative teetering while using a walker, and wonder what one fall – one trip to the emergency room, not to mention a hospital stay or surgery – would cost Medicare? We know that such a hospital visit would cost far more than a preventative $1,200 scooter. In these ways, not only aren’t scooters over-utilized by the elderly, but Senator McCaskill’s wish to restrict their funding even more could most likely increase Medicare costs by not preventing falls and injuries by those who need mobility aids to sustain health and safety.

Lastly, I’d be amiss if I didn’t address Senator McCaskill’s belief that television commercials that advertise scooters and power wheelchairs promote fraudulent use, that such ads encourage those not in need to get a mobility aid through Medicare. Again, people without medical conditions don’t pursue mobility aids. After all, there’s not one argument why a sane, healthy person would see a scooter commercial and decide to pursue a diagnosis and prescription, and try to go through the approval process to get a mobility aid that they don’t need. People without disabilities don’t want to be disabled. By literal comparison, McCaskill’s concern would also suggest that Lipitor commercials encourage those in perfect health to try to convince their doctors to prescribe them the cholesterol-lowering medication even though they don’t need it. The rational fact is that people respond to mobility and medication commercials for the same reason: Existing medical need. If you’re totally healthy, a commercial for a mobility aid or condition-specific medication won’t convince you otherwise. On the other hand, if you have a condition, and you respond to a commercial that advertises a solution, that simply makes you a consumer, not a “fraud” as McCaskill labels beneficiaries who rely on mobility aids.

When one looks at the simple facts – that power mobility aids cost Medicare $1.2-billion annually, not “hundreds of billions” as Senator McCaskill claims; that mobility aids are merely a tiny fraction of Medicare’s annual $430-billion expenditures, not Medicare’s foremost cost as Senator McCaskill suggests; and that the elderly population is reserved toward using mobility aids, not seeking them fraudulently as Senator McCaskill asserts – one truth is evident: Senator McCaskill, of the great state of Missouri, is out of touch, misinformed, and a voice of degradation toward those with disabilities.

Let us hope that the great constituency of Missouri uses its collective voice to reel their junior Senator, Claire McCaskill, back down to Earth, where those with disabilities are respected, not scapegoated for one misguided politician’s hoped personal gain.