http://tinyurl.com/ypstck

One year from today, a new president moves into the White House. This
president will be eager to carry out any number of plans — including,
surely, plans to help the segments of society that most need help.
Extending a helping hand, after all, is one of the great privileges and
responsibilities of the presidency.

But before charging ahead with such plans, the new president might do
well to first ask him- or herself the following question: What do a deaf
woman in Los Angeles, a first-century Jewish sandal maker and a red-
cockaded woodpecker have in common?

A few months ago, a prospective patient called the office of Andrew
Brooks, a top-ranked orthopedic surgeon in Los Angeles. She was having
serious knee trouble, and she was also deaf. She wanted to know if her
deafness posed a problem for Brooks. He had his assistant relay a
message: no, of course not; he could easily discuss her situation using
knee models, anatomical charts and written notes.

The woman later called again to say she would rather have a sign-language
interpreter. Fine, Brooks said, and asked his assistant to make the
arrangements. As it turned out, an interpreter would cost $120 an hour,
with a two-hour minimum, and the expense wasn’t covered by insurance.
Brooks didn’t think it made sense for him to pay. That would mean laying
out $240 to conduct an exam for which the woman’s insurance company would
pay him $58 — a loss of more than $180 even before accounting for taxes
and overhead.

So Brooks suggested to the patient that they make do without the
interpreter. That’s when she told him that the Americans With
Disabilities Act (A.D.A.) allowed a patient to choose the mode of
interpretation, at the physician’s expense. Brooks, flabbergasted,
researched the law and found that he was indeed obliged to do as the
patient asked — unless, that is, he wanted to invite a lawsuit that he
would probably lose.

If he ultimately operated on the woman’s knee, Brooks would be paid
roughly $1,200. But he would also then need to see her for eight follow-
up visits, presumably with the $240 interpreter each time. By the end of
the patient’s treatment, Brooks would be solidly in the red.

He went ahead and examined the woman, paying the interpreter out of his
pocket. As it turned out, she didn’t need surgery; her knee could be
treated through physical therapy. This was a fortunate outcome for
everyone involved — except, perhaps, for the physical therapist who would
have to pay the interpreter’s bills.

Brooks told several colleagues and doctor friends about his deaf patient.
“They all said, ‘If I ever get a call from someone like that, I’ll never
see her,’ ” he says. This led him to wonder if the A.D.A. had a dark
side. “It’s got to be widely pervasive and probably not talked about,
because doctors are just getting squeezed further and further. This kind
of patient will end up getting passed on and passed on, getting the
runaround, not understanding why she’s not getting good care.”

So does the A.D.A. in some cases hurt the very patients it is intended to
help? That’s a hard question to answer with the available medical data.
But the economists Daron Acemoglu and Joshua Angrist once asked a similar
question: How did the A.D.A. affect employment among the disabled?...

http://tinyurl.com/ypstck

One year from today, a new president moves into the White House. This
president will be eager to carry out any number of plans -- including,
surely, plans to help the segments of society that most need help.
Extending a helping hand, after all, is one of the great privileges and
responsibilities of the presidency.

But before charging ahead with such plans, the new president might do
well to first ask him- or herself the following question: What do a deaf
woman in Los Angeles, a first-century Jewish sandal maker and a red-
cockaded woodpecker have in common?

A few months ago, a prospective patient called the office of Andrew
Brooks, a top-ranked orthopedic surgeon in Los Angeles. She was having
serious knee trouble, and she was also deaf. She wanted to know if her
deafness posed a problem for Brooks. He had his assistant relay a
message: no, of course not; he could easily discuss her situation using
knee models, anatomical charts and written notes.

The woman later called again to say she would rather have a sign-language
interpreter. Fine, Brooks said, and asked his assistant to make the
arrangements. As it turned out, an interpreter would cost $120 an hour,
with a two-hour minimum, and the expense wasn't covered by insurance.
Brooks didn't think it made sense for him to pay. That would mean laying
out $240 to conduct an exam for which the woman's insurance company would
pay him $58 -- a loss of more than $180 even before accounting for taxes
and overhead.

So Brooks suggested to the patient that they make do without the
interpreter. That's when she told him that the Americans With
Disabilities Act (A.D.A.) allowed a patient to choose the mode of
interpretation, at the physician's expense. Brooks, flabbergasted,
researched the law and found that he was indeed obliged to do as the
patient asked -- unless, that is, he wanted to invite a lawsuit that he
would probably lose.

If he ultimately operated on the woman's knee, Brooks would be paid
roughly $1,200. But he would also then need to see her for eight follow-
up visits, presumably with the $240 interpreter each time. By the end of
the patient's treatment, Brooks would be solidly in the red.

He went ahead and examined the woman, paying the interpreter out of his
pocket. As it turned out, she didn't need surgery; her knee could be
treated through physical therapy. This was a fortunate outcome for
everyone involved -- except, perhaps, for the physical therapist who would
have to pay the interpreter's bills.

Brooks told several colleagues and doctor friends about his deaf patient.
"They all said, 'If I ever get a call from someone like that, I'll never
see her,' " he says. This led him to wonder if the A.D.A. had a dark
side. "It's got to be widely pervasive and probably not talked about,
because doctors are just getting squeezed further and further. This kind
of patient will end up getting passed on and passed on, getting the
runaround, not understanding why she's not getting good care."

So does the A.D.A. in some cases hurt the very patients it is intended to
help? That's a hard question to answer with the available medical data.
But the economists Daron Acemoglu and Joshua Angrist once asked a similar
question: How did the A.D.A. affect employment among the disabled?...

--
Fred Stone
aa# 1369
People who think with their epidermis or their genitalia or their clan
are the problem to begin with.
C. Hitchens