[The following was originally published in the February, 2011 edition of HME News as a Valentine to the Durable Medical Equipment industry. The love continues.]
I was so angry, wild with fatigue, that I lifted my ugly drug store cane intending to destroy my employer’s computer printer. This was in California’s Silicon Valley. The printer was networked to nine computers. After a late night writing a portion of a manual on silicon wafer inspection, I commanded the computer to print.
After I weaved my way to the printer (seemingly miles away from the computer), there was no document. Five trips back and forth (nothing each time) and my level of frustration caught up to my level of exhaustion. My control was at the breaking point.
Six months previously, I had lost my ability to walk. The concepts I was writing about were hard to understand even when I had been healthy and well-rested. My ability to physically support my body was shaky. I fell several times a day. My right arm had been badly dislocated in a fall. What I needed was a fore-arm crutch with properly fitted prosthetics or a scooter. My doctors focused on understanding how I lost the ability to walk and little on how I could live without walking.
Mortgage payments were due. Home was North Carolina where a wife and two elementary-school-aged children waited. The local economy determined technical writers were not currently needed. At the same time (1996), California needed my skills as of yesterday and I was promptly hired for KLA-Tencor, a company paying large sums to do fascinating work.
I did not break the printer. I drove to my apartment, slept and thumbed the yellow pages praying for relief. I did not know what I was looking for. After a while, I left a voice mail with a dealer in wheelchairs and scooters (not knowing then what a scooter was). That is how I purchased my first mobility device.
Scott returned my call and listened to my situation. We talked price. He recommended a used front-wheel drive scooter. I was skeptical. “Let me show you how it works,” he said, crossed town quickly and lifted a scooter from his truck. I sat down and drove circles around the empty street. My able-bodied college friend David Phillips, in whose house I had an apartment, was fascinated. Keeping David from driving my scooter was hard.
I had discovered three important things about mobility devices:
They are fun.
They take away the drudgery of not being able to walk.
They remove the image that I am someone to be pitied.
I arrived at KLA-Tencor, having:
Given Scott a down payment (the beginning of many, mostly personal, expenditures, on equipment, including rear-wheel drive scooters, power chairs, wheelchair lifts and ramps)
Taken the scooter apart myself and shakily inserted the parts into the trunk
Slid sidewise hugging the Pontiac’s body
Reversed the process
My colleagues applauded. I had solved a physical problem with a technical solution and in the Silicon Valley that was worthy of commendation.
As I look back on the past 14 years, especially worthy of commendation are you, the suppliers of DMEPOS. My time with you here is almost up. Traditionally a column is about 750 words. I have used most of them. A 750-word column can express effectively only one major idea. That idea is that you, the medical suppliers, and people like me, your customers, are a family.
We are a family surviving in a world where David Stockman, Ronald Reagan’s former budget director, said in November on ABC News that the United States can no longer afford to provide its disabled citizens with “scooters.” As competitive bidding illustrates, clearly a bipartisan effort is underway to make it difficult for the disabled to receive mobility and other DMEPOS devices and for you, our local medical suppliers, to get paid for them or even to stay in business.
The pain is especially felt by indigent consumers and small suppliers. In this month where every day is Valentine’s Day, it is helpful to remember the words of Benjamin Franklin (an amorous man if ever there was one) on the signing of the Declaration of Independence: “We must all hang together or assuredly we shall all hang separately.”
–Joel Solkoff is a monthly columnist on disability and elderly related issues for Voices in State College, Pa. He is the author of three books, including The Politics of Food and Learning to Live Again: My Triumph Over Cancer. He served in the Carter Administration as Special Assistant to the Under Secretary of Labor. He has a bipartisan loathing of anyone trying to keep assistive technology from individuals with disabilities—a loathing he is trying to turn into corrective love.
You call the enthusiastic endorsement of Tavenner by Rep.Eric Cantor, House Republican Majority Leader, “Republican opposition.” Give me a break Senator Baucus.
Here is what I told Katrina vanden Heuvel , the editor and publisher of the Nation Magazine [who appeared this Sunday as a refreshingly articulate advocate for abandoning the current foolish policy of austerity above all else on This Week with George Stephanopoulos ] when she asked me to give my younger daughter a gift subscription as a college graduation present:
“I am shocked by The Nation’s failure to report on the deterioration of the current Medicare system which as a recipient and a left-of-center Democrat, I can report on what is actually going on (despite the Nation’s unexamined rhetoric). Indeed, I have suggested that I write about it for you to no avail. Hence, no subscription for my daughter Amelia: http://www.joelsolkoff.com/blueroof-reality/countdown-to-amelias-graduation/”
In response to the report from the Wall Street Journal below: 11:52 pm May 21, 2012 Joel Solkoff wrote :
The failure of Max Baucus and the 12 Democratic members of the Senate Finance Committee, many of whom are liberals whose rhetoric on saving Medicare is voluminous, to hold hearings on Marilyn Tavenner to be head of Medicare and Medicaid is a disgrace. As a paraplegic who has experienced the deterioration of Medicare as it currently exists under President Obama, the fact that his Administration has not had a confirmed Administrator reveals the sharp disparity between a President who lauds Medicare while cutting its budget by half a trillion dollars as part of the cynical price paid to ensure passage of Obamacare. Eric Cantor’s support of Tavenner would have forced Senate Republicans to think twice about voting against her. As one who enthusiastically supported the President four years ago, my unenthusiastic vote for his re-election is indicative of the lukewarm support that could cost him the election. The Nation, The Progressive, and other presumed defenders of Medicare have failed to be critical of the President’s penny-wise, pound foolish administration of a program which he is currently destroying while speaking eloquently about preserving its future. A genuine confirmation hearing for an Administrator whose budget is larger than the Pentagon’s is long overdue. Failure to hold hearings undermines the Democratic pretense that Medicare is worth saving and makes me ashamed to admit that I am a Democrat. What happened to the party of Adlai Stevenson and Eleanor Roosevelt? The best way for Obama to prove his credibility is to push for the support of his nominee and to indicate his commitment to what used to be Democratic values.
112th Congress (2011 – 2012)
Date Received: December 01, 2011 (112th Congress)
Nominee: Marilyn B. Tavenner, of Virginia, to be Administrator of the Centers for Medicare and Medicaid Services, vice Donald M. Berwick, resigned.
Referred to: Senate Finance
Floor Action: December 01, 2011 – Received in the Senate and referred to the Committee on Finance.
Organization: Department of Health and Human Services
Now for some background information. In December, I published the following article in HME News, the publication for the home medical equipment industry which may help you understand the circumstances behind the nomination of Marilyn Tavenner to head the half trillion-dollar agency which significantly affects the life and health of all Medicare and Medicaid recipients.
Who is in charge of Medicare?
The wide-ranging debate over Medicare, a major factor in the presidential election next year, primarily focuses on whether future generations will benefit in the same way that the current 46 million recipients like me benefit. Politicians, critics and would-be-recipients express the illusion that the health care I receive from Medicare represents the ideal. I believe that the only way to save Medicare is to dramatically improve the way it is run today so that it remains a program worth saving.
The primary audience for this commentary is the men and women who provide DME other equipment necessary to sustain and maintain the quality of life. Recently, 87-year-old Lilian Hutchinson, who gets around on an unstable walker, fell and broke her elbow in an independent living facility for 90 elderly and disabled residents where I live in State College, Pa. I believe that if Lillian had access to a scooter or a power chair in her apartment, she would not have fallen. The tales of needless suffering you could tell resulting from a Medicare bureaucracy that increasingly limits access to mobility equipment and medical oxygen seem beside the point.
Durable medical equipment represents only a small fraction of the Medicare budget. The whole system for providing medical care for the elderly, disabled and poor is not working efficiently in large part because of the absence of leadership at CMS, an agency of the U.S. Department of Health and Human Services. My intention here is to answer the question: Who runs Medicare? In theory, Dr. Donald Berwick, a distinguished Harvard physician with an outstanding reputation as an advocate for efficient health care, runs CMS.
Last year, President Obama named Dr. Berwick to be administrator of CMS, a position one senator described as the nation’s health czar since the job also includes putting in place much of the legislation passed last year, which, by one estimate, will extend health care to 32 million Americans who do not have coverage.
Sadly, the president had failed to appoint an administrator early on in his administration, when Senate confirmation would not have been a problem and when an adviser with the expertise and gravitas Dr. Berwick has in the medical community would have proven useful. The major flaw in the president’s landmark legislation was how he intended to pay for it. He decided against raising taxes, which might have doomed passage.
Instead, half the estimated trillion dollars required to extend healthcare coverage was targeted to come from savings to the Medicare budget as a result of achieving cost savings, reducing fraud and abuse, and increasing efficiency. Anyone who has ever made a New Year’s resolution to save money can tell you it is imprudent to spend it before the money is actually saved.
By the time Dr. Berwick arrived at Medicare, he was in the impossible situation of being required to save $500 billion, a requirement for which he had not been consulted and in a situation where the president had given him neither the time nor the authority to implement.
The political comedian Mark Russell observed, in a similar context, that exercising leadership without the necessary authority is equivalent to sending a eunuch to an orgy. Fearful of Republican reaction to Dr. Berwick’s appointment and unsure of the allegiance of Democrats on the Senate Finance Committee, the president refused to fight for Berwick’s confirmation or to find a replacement who would achieve bipartisan support.
Using the recess appointment mechanism, which allows a president to appoint an official on a temporary basis while Congress is not in session, Berwick currently serves as acting administrator and will be replaced next year by his deputy Marilyn Tavenner. Tavenner, while respected for her organizational skill, her background as a nurse and a hospital and state health care administer, does not have the stature required to lead what is in effect a cabinet level position.
Although CMS has a larger annual budget than the Pentagon, as I write this, there has not been a confirmed head of Medicare since 2006. For the purposes of comparison, if the Defense Department did not have a confirmed secretary for five years, there would be a national outcry.
–Joel Solkoff was a political appointee in the Carter Administration, serving as special assistant to the Under Secretary of Labor. He believes a bipartisan solution to the problems of Medicare is achievable.
On February 3, I sent the following letter to Senator Max Baucus (D Montana), chairman of the Senate Finance Committee which has oversight over Medicare and has the power to conduct confirmation hearings on President Obama’s nominee to run Meadicare:
The Honorable Max Baucus
Committee on Finance
United States Senate
219 Dirksen Senate Office Building
Washington, D.C. 20510
Dear Senator Baucus
I am writing to request an invitation to testify at the confirmation hearing of Marilyn Tavenner to be Administrator of the Centers for Medicare and Medicaid Services.
I am a paraplegic who is a Medicare recipient. While I am generally supportive of Acting Administrator Tavenner’s appointment, especially since it has been so long that CMS has had a confirmed Administrator; I have considerable concerns about durable medical equipment. As a user of mobility devices and as one who has researched other equipment in the durable category, especially medical oxygen, I think it important that my concerns be discussed.
Specifically, I am concerned about the cumbersome procedures involved in obtaining medical equipment. The current competitive bidding program, the absence of assurances that award winners will provide batteries, other necessary equipment, and maintenance are among the issues on which I would like assurance—both from Acting Administrator Tavenner and from the Senate Finance Committee with its oversight responsibilities.
I realize that no hearings have been scheduled as of this writing. However, given the importance of Medicare and Medicaid I would appreciate my voice being heard, especially on the subject of indigent disabled individuals who have suffered most from current and proposed CMS practices.
I write frequently on disability issues for Voices of Central Pennsylvania, HME News, the monthly publication of the home medical care industry, and for a variety of other publications. I am the author of three books including Learning to Live Again My Triumph over Cancer. My disability writing can be accessed easily by keyboarding my name into Google.
Of course I cannot testify unless there are hearings.
For a number of reasons, it seems likely that Marilyn Tavenner is not a controversial nominee and the committee and the Senate would vote to confirm her.
It is hard to run something when you do not have the necessary authority.
Politicians are using this election season to talk about the important of Medicare and Medicaid. If they really believe what they say they would hold confirmation hearings.
There has not been a confirmed had of Medicare since the Bush Administration.
Naturally, I begin with myself. The primary theme of my website is based on a scholarly body of literature known as experienced-based design which for the layperson, such as myself, means that I should have a role in the design of the world I live in.
2. My focus. Specifically, I am focusing on two separate worlds (or perhaps world views would be more correct); namely:
Reality: the design of housing for elderly and disabled individuals such as myself
Virtual reality: the tool that makes it possible, economical, and more efficient to create a 3-D model that can be used as a template for the massive construction effort required to house the elderly population here in Rust Belt, PA, and as we age; we “baby boomers” who constitute the largest generation in our country and indeed the world’s history. Stay tuned for more on this demographic reality and its impact.
McKeesport, PA is the unlikely location for a presentation of how the reality of technology currently being constructed should serve as a model for the future. The overriding example presented here is a non-profit corporation BlueroofTechnologies founded 10 years ago, where I spent three days and two nights in December as the first invited guest at the Blueroof Experimental Cottage shown here with Blueroof’s founders on the front porch (a front porch identified by elderly residents as being significant to their sense of well-being):
Next is a photograph of next door in decaying McKeesport. Notice that the road and sidewalk are rotting, and the door and everything else about the building has been demolished, but the wheelchair-accessible curb cut is brand new. (Stay tuned for more on McKeesport‘s curb cuts to nowhere.)
The principal characters in this encomium to Blueroof’s founders are Dr. Robert Walters, (left) a former engineering professor at the local campus of Penn State, and John Bertoty, a retired principal of the local high school.
My under construction profile of John’s cofounder reads: “Robert Walters is the kind of engineer who collects more data than he knows what to do with, but wants more.” Bob currently is collecting data on the number of times the residents of a non-experimental Blueroof residence open their refrigerator doors.
Assume your 86-year-old mother is living alone in an apartment (which is basically what a Blueroof Cottage is). If she has not opened her refrigerator door for three days, that indicates something is wrong. The wired cottage alerts you in a timely fashion and you are able to get there before three days, whatever default Bob contrives. Instead of arriving at Mom’s residence to find her passed out on the floor, requiring an ambulance and who-knows-what, you are able to get over there and help your mother out.
This is a device Bob contrived to measure activities of daily living (ADL) and signal alarms and phone calls for help. The wireless BlueNode System (motion detectors and other sensors not shown, nor the refrigerator):
University Park, PA. is a two and a half drive east and north from McKeesport. Here the Penn State Department of Architectural Engineering (AE) is home of the Smart Spaces Center for Independent Living, an interdisciplinary group which has the capability to help Bob Walters process the data he obtains and find useful applications.
One place where Bob’s data are applied is in the AE Department’s Immersive Construction (ICon) Lab and now is the time to put on your 3-D glasses:
The principals at University Park are:
Dr. Richard Behr, Director of the Smart Spaces Center for Independent Living and professor of architectural engineering.
Dr. John Messner, director of the Computer Integrated Construction (CIC) Research Program (which includes custodianship of the virtual reality lab) and professor of architectural engineering.
[No, I do not know why John and Sonali’s photos came out larger than Rich’s and my wonderful IT guru is asleep. Who wouldn’t be at this hour?]
Sonali Kumar, graduate assistant to John M. and the 3-D modeller who turned me into a virtual reality avatar.
Now more on each:
Dr. Richard Behr has been the prime visionary on all of this. As Director of the multidisciplinary Smart Spaces Center, Rich has been a prime mover in the effort to foster aging in place long before it because a recognized goal. He has focused on retrofitting existing residences so the elderly could continue to live in their traditional homes and in supporting the development of Blueroof and the use of virtual technology in Dr. Messner’s CIC Program.
“These technologies,” Dr. Behr writes, “are often grouped into three broad categories based on their function and value: those which
(1) address safety at the environmental level,
(2) secure health and wellness at the individual level, and
(3) enable social connectedness at the community level .”
Dr. John Messner uses virtual technology to design health care facilities. Shown here are pharmacists from the Washington, D.C. area viewing a Kaiser Permanente health care facility not yet constructed. The pharmacists drove from DC to State College (quite a schlep, try it sometime) to view their future workplace and make important design changes before building began.
Sonali Kumar built this 3-D model of me as an avatar getting ready to take a shower:
Sonali is completing her doctoral work on experienced-based design, which this is. As I keyboard this posting, I frequently glance at her award-winning poster entitled “Experience-Based Design Review of Healthcare Facilities Using An Interactive Prototyping System.” Shown here is one of the experienced-based design consultants Sonali used to research the effectiveness of an interactive prototyping system, Lilian Hutchison, my 87-year old neighbor:
4. Baby Boom Demographics
One out of every four Americans is a part of the Baby Boom generation which the U.S Census Department defines as those 76 million Americans born between 1946, the year after World War II ended, and 1964 when prodigious use of birth control and other factors caused the annual birth rate to fall below 4 million.
The first baby boomers have already begun to retire despite the fact that most jobs in the United States are held by baby boomers. When the members of my generation give up their jobs a whole slew of disaster scenarios appear—whether you go to the U.S. Census Bureau’s excellent website or consult Google’s index and find this expression of impending disaster:
5. Who is the primary audience for this information? Why it is the Ford Foundation, based in New York City which has demonstrated a tradition of providing funding for significantly innovative projects that improve the lives of indigent, elderly, and disabled individuals throughout the world (and the world includes the United States).
Ford has a tradition of distinguished leadership exemplified by McGeorge Bundy, who left Lyndon Johnson’s White House to become Ford’s President.
Today, the President of Ford is Luis Antonio Ubiñas. His official biography notes: “Prior to joining the Ford Foundation, Luis was a director at McKinsey & Company, leading the firm’s media practice on the West Coast. He served technology, telecommunications and media companies, working with them to develop and implement strategies and improve operations. Much of his work focused on the opportunities and challenges represented by the growth of Internet and wireless technologies.”