Tag Archives: Jean Paul Sartre

Saving Medicare billions: Trying too hard can get in the way

Ambulance parked in front of my bedroom window waiting to pick up a neighbor

Today is Sunday, February 26, 2012.  I took the photograph above last week. My apartment is within an eight-story building housing 90 low-income elderly and disabled individuals, an ambulance parks outside my window at least once a week. Sometimes my neighbors and I return. Sometimes, not. The cost for Medicare, Medicaid, and other services to go on the gurney ride to the hospital and beyond is many times higher than the cost of preventing and treating.

The following article appeared in the October, 2011 issue of  HME News and it still reflects an ongoing concern. Following the article, I will provide a memorial note on one of the residents who did not return.

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The money saved as a consequence of concentrating on what is right will astonish the body politic

” I have saved up enough pills to kill myself,” a neighbor told me, “if I ever have to go to Centre Crest.”

I live in an independent housing apartment building in downtown State College, Pa. The nearly 100 residents of Addison Court are disabled or elderly. Most of us are poor–the more affluent are on Social Security or Social Security Disability and Medicare.
At least once a week, the ambulance stops by my window and a resident goes off to the hospital. The lucky return. The not-so-lucky move on to Centre Crest, the default public nursing home about 11 miles away, where assisted living means expensive round-the-clock care, diaper changes, attachment to machines that keep the biological aspects of life going, medical personnel who make sure medications are taken correctly, and a world view that echoes Dante’s inscription over Hell: “Abandon hope, ye who enter here.”
Last year, Pennsylvania’s Department of Aging estimated it costs Medicare $40,000 extra each year for a resident to move from an independent living to an assistive living facility. The loss of dignity to the individual is incalculable.
The French philosopher Jean Paul Sartre observed that when one tries especially hard to listen, often the trying gets in the way of hearing. Medicare is trying too hard to do the wrong thing. Medicare‘s purpose is not to save money, but to provide health care in a way that concentrates on improving the quality of life. Recent evidence on the brain’s adaptive capacity provides hope that not only can individuals resume physical capacity from the devastation of a variety of afflictions that affect us at Addison Court, but also we can regain our talents to improve this society, not simply take from it.
“The Brain that Changes Itself, Stories of Personal Triumph from the Frontiers of Brain Science,” by Columbia University’s Norman Doidge, M.D., points to the brain’s ability to recover from strokes and other disorders with rehabilitation and concern.
“Traditional rehabilitation,” Doidge writes, “typically ended after a few weeks when a patient stopped improving, or ‘plateaued.’ And doctors lost the motivation to continue.  But…these learning plateaus were temporary…Though there was no apparent progress in the consolidation stage, biological changes were happening internally, as new skills became more automatic and refined.”
The Obama administration’s penny-wise-and-pound-foolish cutbacks on availability to durable medical equipment, rehabilitation services, and home health care are forcing residents of independent living facilities into the Centre Crests of this country. For example, the narrow focus is apparent in Medicare‘s frequent citations of the Congressional Budget Office‘s competitive bidding estimates of relatively insignificant savings for Medicare Part B ignoring the astronomical costs that will result to Part A when disabled individuals like me can no longer pick up the phone and call my local medical equipment provider. Instead, I must wait for a competitive bidding winner (several have unsavory reputations and some are based out-of-state) to provide a battery. Delays could easily force me into Centre Crest as a result of falls, problems getting to the bathroom, etc. Delays would rob me of the ability to work as an adviser on virtual reality models for construction of future aging in place housing–construction which will result in significant Medicare savings.
Medicare is discouraging the necessary alliance between rehabilitation therapists and medical suppliers. This alliance will help restore the ability of my fellow residents to function and contribute to society.
“Individuals with disabilities remain one of our nation’s greatest untapped resources,” said Rep Jim Langevin, D-R.I., the only quadriplegic in Congress. To release the untapped resources of the elderly and disabled, Medicare must stop thinking about saving money and start thinking about improving health. The money saved as a consequence of concentrating on what is right will astonish the body politic. Providers of durable medical equipment require the support of consumers like me. Providers and rehabilitation therapists have been slow to recognize that in unity there is strength. Together they must spread the word that when an individual becomes old or disabled, science is rapidly increasing the ability to regain talent and good health.
–Joel Solkoff is the author of “Learning to Live Again, My Triumph over Cancer” and is adjunct research assistant at Penn State’s Department of Architectural Engineering.
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Memorial Note: Tonight, November 14, 2011, Jack Seidner aged 93, my neighbor and friend at Addison Court, State College. PA, died while talking to his son who had called from Israel. He died at Centre Crest, an assistive care facility in Bellefonte, PA, 11 miles from Addison Court.
Jack was a veteran of World War II and was a monthly calendar boy on the Jewish War Veterans calendar last year  He will be buried beside his wife in Harrisburg at a private funeral.
Jack was a wonderful man. He was basically an intellectual although he hid it as much as possible. When I wrote a story about home medical oxygen, oxygen which he received to stay alive, he refused to be photographed saying, “I have been studied enough.”
His sense of humor was ever-present, sometimes to the point of reciting bawdy limericks to the residents of Addison Court. I will miss him. He died at Centre Crest. The article below, originally published in HME News on September 27, 2011, is dedicated to his memory. In these days of turmoil at Penn State University, the need to care for the real needs of this community should be apparent.

New column speaks to disabled, elderly issues–from Voices of Central Pennsylvania

July 2017. State College/University Park, PA. Years later, this reflection on the Sandusky scandal still rings true:
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“As a former graduate student at Penn State with a disability and as one who is part of the elderly community, the focus by powerful officials on football-above-all has also been used to cover up exploitation of disabled and elderly students and students who are veterans (especially disabled-veterans) and to discourage recruitment of such individuals to become students. Also, this exploitation has extended to the community economically dependent on Penn State.”

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Note: I am in the process of critiquing the report issued by former FBI Director Louis Freeh issued in July of 2012. The report, which was commissioned by the Board of Trustees at Penn State, concerned what is popularly referred to as the Sandusky sex scandal. Freeh, in issuing the report, pointed out the danger of the "football culture" at Penn State which gave license to officials in power to ignore predatory sexual practices on children. 
As a former graduate student at Penn State with a disability and as one who is part of the elderly community,the focus by powerful officials on football-above-all has also been used to cover up exploitation of disabled and elderly students and students who are veterans (especially disabled-veterans) and to discourage recruitment of such individuals to become students. Also, this exploitation has extended to the community economically dependent on Penn State. As partial background regarding this contention, I am here republishing the monthly column I wrote for Voices of  Central Pennsylvania, then edited by the gifted Suzan Erem. The column appeared from October of 2009 until February of 2011. What follows is the first column.

From Where I Sit

In high school I was a junior befriended by a sensual senior who shared her physical love with others, but talked philosophy to me. I would have preferred it the other way around, but I had no choice. If I wanted to benefit from the privilege of being in her presence (and I did), then I had to sublimate my lust by talking about existentialism—
Sallie’s philosophical passion.

Existentialism is not as chic today as it was when I was 15 or 16. Jean Paul Sartre had not yet refused the Nobel Prize in Literature, nor had he turned his back on literature—deciding finally to complete Being and Nothingness and other non-fiction. The central philosophical question that haunted us adolescents—Why am I here?—remains through our old age.

For me the question takes on an added dimension. At 28 I was diagnosed as having a relatively rare form of cancer that a generation earlier killed virtually everyone who had it. For much of my early adulthood, an astonishingly large number of physicians believed the disease was universally fatal. Oxford University Press published an impassioned plea to physicians to reconsider their notions of doom. Today, the disease is nearly universally curable. For a while, the people who began the cure with radiation machines underestimated its power and a large number of radiologists died while curing others. My radiologist at George Washington University Hospital in Washington D.C. died before I reached the five-year disease free mark. Seymour Kaplan, the Stanford University radiologist who published the Oxford medical text, suffered a similar fate.

I lost the ability to run, walk, or stand without assistance, but the disease and its consequences did not prevent me from fathering two beautiful daughters. Why am I here? has become a consistent theme in my life. Consistent themes make it possible for people to become columnists for newspapers and for publications such as
Voices of Central Pennsylvania. So, what you are reading is the first in a series of monthly columns on the subject of having physical disabilities and being elderly here in Centre County.

I will not pretend that physical disabilities and old age are inherently fascinating subjects. However, one of the advantages of being a columnist is that I do not have to come to the point too quickly—as long as I get there. So for my readers, beginning
October, 2009 I plan to use my wiles to make me part of your life. I plan to start here at Addison Court, the 89-apartment complex in downtown State College, where at 3 a.m. nearly every day drunken students out of control (half a block from the police station) walk east in groups of 20 shrieking men and women who pause to urinate and vomit in our parking lot.

I plan to find out why the police do not interfere with drunken activity and how it makes Addison Court residents feel.

I can’t wait for you to meet my neighbors. A few weeks ago, Lillian (83), Audrey (80), Hilda (90), and I had a lively Corner Room breakfast talking about what it is like when most of one’s friends are dead or too-far-gone to remember the same old stories.

Addison Court residents, with the exception of those with physical and emotional disabilities, are 55 or older, live in rent-subsidized apartments, have little money, not enough to do, and most vote out of a sense of patriotic obligation.

From Addison Court, half a block north on Allen, is Webster’s Bookstore Café. Webster’s proprietor Elaine Meder-Wilgus surrounds herself with serious reformers who are not afraid to have fun. This column will discuss reform and fun from my distinct perspective. I am 62. I am a paraplegic. I have rotten teeth—17 cavities.

I have strong ideas about the importance of uniting with others such as myself because as Al Smith once said, “The only cure for the ills of democracy is more democracy.”

In the November column, I will tell you why I came to State College, how much money I earn, and how I plan to survive financial disaster.  [October 2009]

Joel Solkoff is the author of The Politics of Food.