Editor's Column - April 2009

timbenjamincolorI want to thank the Minnesota Coalition for Citizens with Disabilities (CCD) and all of the organizations that have worked so hard over the last couple of months to successfully organize rallies and lobbying efforts at the capitol and elsewhere. I know many of these people fairly well, and I’ve never seen before the distress I now see in their eyes, or heard the apprehension in the conversations we’ve had regarding the needs of the disability community. These friends put in long hours and do excellent work teaching and influencing our legislators and policymakers to do the best thing for the disability community. We do have many legislators at the Capitol who are huge supporters of our community and do their best to maintain the services that we need to stay independent. But things are changing, costs are going up, and many of our programs will lose some financial support. I continue to feel confident that with the Minnesota CCD, knowledgeable legislators, and all the wonderful self-advocates in our community, we will retain our programs at the highest possible levels.

Concerning the article on Minnesota Disability Health Options (MnDHO) and Axis Healthcare, I’m not sure that the numbers the governor is using to analyze the progress of the program are the right ones. Axis Healthcare is being judged on approximately 1,200 participants, and the state Medical Assistance program is being judged on 90,000 consumers. If one of the 1,200 individuals on Axis has an episode that is very costly, it’s easy to see the catastrophic loss to the program; but if one of the 90,000 on the MA program has the same episode, that loss doesn’t look so disastrous to the overall program. Another way to think about it: if you take 2,000 folks off the Axis program, the program loses 17% of its clients, but if you take 2,000 people off the medical assistant program, you’ve cut just more than 2% of the participants.

For myself, I know that Axis, in pursuing a proactive approach, has saved money for the Department of Human Services. How much money exactly, I couldn’t say—because it’s always difficult to estimate the cost of problems avoided. But I can say that prior to becoming an Axis consumer, I was hospitalized often for various conditions, and since 2005, when I became an Axis client, I have NOT been hospitalized. How do we estimate the cost of maintaining good health? Sure, it costs money to stay healthy but what’s that compared to the cost of being unhealthy? That’s the dilemma right now in the health insurance industry: is it cost-effective not to treat a urinary tract infection or follow up with frequent diagnostic examinations? The only way to know is to compare those costs to the ones of a serious infection with painful symptoms, or to a resulting kidney infection that requires hospitalization and creates other complications like, say, having to remove a bladder—or death. Of course if you follow the “what’s cheapest” thinking to its logical extent, the last option is obviously the cheapest; don’t treat illness long enough, and eventually there’s no more cost to society for one less person participating in expensive healthcare programs!

The government seems to be recognizing the costs involved in smoking. Policy makers are spending lots of money to encourage people to quit and stay healthier, and so are avoiding the costs of emphysema, lung cancer, heart attacks, and all the other effects related to that bad habit. We should applaud the government for that. But they haven’t done the same in so many other areas. Let’s get them to focus clearly on the cost savings, let’s say, in keeping someone with a mental health issue on the right medications to ensure that that person remains a productive member of the community. Let’s help educate legislators on the kinds of research in which experts show the comparative costs of prevention versus critical care. For example, a 1991 study by Staas, Cioschi, and West or another by Lyder in the Journal of the American Medical Association in 2003, illustrates how providing appropriate seating and other preventive measures might cost around $5,000 or $10,000 per sore and they compare that to estimated costs of $500 to $40,000 for treating a pressure sore once it develops. If you don’t know research like this in your area of healthcare and disability, talk to your advocate organizations, or talk to your librarian. Then talk to your legislator. Our lives depend on it.