Whether It Is or Not, It’s What Rationing Will Sound Like

TPublico constructively offers correction of my mention of proposed healthcare-reform changes to wheelchair purchases under the Social Security Act:

That specific section in the Health Reform Bill has nothing to do with rationing, or as the source says ‘…if you don’t specifically need the motorized chair for complex rehabilitation, Obamacare says you can freaking walk or crawl from now on. Or pay for it yourdamnself. …’
Here’s the section of the Social Security Act as it is now that the HRB would modify:
(iii) Purchase agreement option for power-driven wheelchairs.—In the case of a power-driven wheelchair, at the time the supplier furnishes the item, the supplier shall offer the individual the option to purchase the item, and payment for such item shall be made on a lump-sum basis if the individual exercises such option.
So if someone needs a motorized chair, they’ll still be able to get it… it only modifies a purchase agreement option – an option that is only in there because payment for the rental item (wheelchair) must be made on monthly basis. That source’s interpretation is completely false, and way off base.
(I) In general.—Except as provided in clause (iii), payment for the item shall be made on a monthly basis for the rental of the item during the period of medical need (but payments under this clause may not extend over a period of continuous use (as determined by the Secretary) of longer than 13 months).

Following on the Lee Drutman piece to which I linked this morning, I lack the time and motivation to research this minute point across the range from Congressional debates to somebody actually buying a wheelchair, but the “way off base” accusation strikes me as a bit strong. Begin with the fact that, in the actual SSA language, the part about rentals (subsection I) is at a lower level of a different branch than the part about purchase agreements (subsection iii). The end user has three options: rent, rent to own, and straight-out purchase.
Heretofore, the choice to buy the machine outright, rather than rent it, followed the language that TPublico quoted. The Affordable Health Choices Act of 2009 changes that language such that it only mentions “certain complex rehabilitative” power-driven wheelchairs and limits the equipment to “complex rehabilitative power-driven wheelchair recognized by the Secretary as classified within group 3 or higher.”
It’s entirely possible that this amounts to a mere clarification of a practice already in effect, but it would seem likely that there’s a more substantial reason for the change. It could be that this specific measure will cut down on waste, because people have been buying equipment that they really only needed for a few months. Or maybe, in the other direction, dealers want the rental option pushed because, by the time they turn over ownership after thirteen months, they’ve charged 105% of the purchase price. Or the government may be looking to limit people to a few months of rentals when they really could use the wheelchair in perpetuity. The bottom line is that a payment option that was available for power-driven wheelchairs is now only available for a limited class of power-driven wheelchairs. If that’s not rationing, it sure sounds like it. (Keep in mind, of course, that I personally don’t think the government should be paying for private medical equipment at all.)
More to the point — inasmuch as I raised this as an example of method, not of implementation — it remains serviceable as a taste of how a massive government-directed bureaucracy will sweep away benefits: with a few words requiring deep expertise in the midst of large, complicated legislation, and with references that snake from the legislation, through another piece of legislation, to a document or judgment from another government office, and then to who knows where, such that we blog disputants can debate at length what the whole thing means. And let’s not forget that the current debate is over the House version of the bill. The Senate version will be different, and then the legislation presented for the president’s signature could be different again.

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14 years ago

The supplier will no longer be able to get the lump sum payment for basic powered wheelchairs and have to wait 13 months for their 105%, it’s bad for cash flow and only the largest suppliers will be willing to provide these chairs, if any. It will also push suppliers into trying to justify more expensive “complex rehabilitative power driven wheelchairs so they don’t have to wait 13 months for their 5% profit.
The end user gets to make this decision, by the way, and it really makes no difference to that person how the supplier makes or does not make money… until they can’t find a provider because medicare reimbursement has driven everyone out of the market.

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