Wednesday, September 16, 2015

What is the "Appearance of a Normal Gait"

Yesterday, a lot of my Facebook friends got an update from me that I felt was pretty cool. I got a lot of feedback from it that was very positive. I was on my way home when my wife called and asked me to swing by the grocery store and pick up a couple of items we needed. I pulled into the lot and immediately headed toward the handicap parking. There were 5 open spots and I took the one furthest from the door. It's a decent spot and I have a blue tag, I wasn't doing anything wrong, in fact, I felt pretty good about the fact that I took the furthest handicap spot that was there. I got out, locked my truck and headed into the store. About this time a woman coming in from the lot behind me shouted "Hey, you know those spots are for people with handicaps, right?"  I stopped and faced her, and said "I am, but thank you for speaking out about it. Too many people abuse those spots."   I think that she noticed that my pant leg didn't quite fall correctly down my leg and my ankle was showing. She started to apologize and I know that she was feeling embarrassed about saying anything. I made light of the whole situation and I found out that her mother is handicapped and that she has to take her shopping she sees a lot of abuse use of those slots. I told her that I was very happy that she thought I wasn't handicapped. It means a lot to me that most people are unaware of my condition, because it means that I have come a long way in the six months since my amputation.

But it did bring up a question has been tickling the back of my brain since I first saw it in the proposed LCD DME changes to Medicare coverage. What is the appearance of a normal gait? Who exactly is to determine what is normal? How is this not a derogatory term when speaking of someone with a physical disability? The entire idea of normalizing something is based in the subjective observation of an individual, and one's opinion of normal will differ wildly from another's opinion.

The more that I think about these changes to the guidelines, the angrier I get. It is terribly obvious that people that do not have a disability are writing them. It is all about the money involved, and even though these changes do not directly affect me right now since I am not on Medicare, they will indirectly influence my insurance company and their decision on how they will cover my prosthetic care. As a community of amputees we stood up and took the fight to the one hearing they had on the proposed changes, but that cannot be the end of the battle. I have a little bit of experience in politics, having served on the city council in Johnson, Arkansas for a term. I would have continued in the position, but my family and I moved to another city.I learned a lot from that short stint in office; like how certain people in politics do what is best for themselves, rather than what is best for the community as a whole. There are some people at CMS that the changes will benefit. Lower overhead costs will allow for further waste in excess personnel as well as allowing for them to remain under budget.

These changes are primarily a function of a government run, politically motivated money scheme. The CMS is under pressure to hold the medical billing down to a minimum, while supporting as much as they can afford in benefits. Rather then attacking the cost of the items that they cover as being too expensive, they would rather not buy it at all. It reminds me of two things. The war on drugs where the DEA goes after the end user rather than the supplier, and the pharmaceutical industry, where future research is funded by an effective monopoly on proprietary knowledge. I do support that if they lay out a boatload of money for research, they should be able to recover that cost and add a reasonable profit before releasing the drug to generic use. I hate to say that there is a corollary with prosthetic devices, but the difference is that we only have less than 1% of the population needing them. Research and development outruns the usage of the devices as the next big thing appears. A streamlining of the industry to follow similar paths of research might be called for, but as technology races forward the cost of prosthetic devices probably will also.

We all want a natural gait, to appear to be unaffected by our handicap to others. While this is an end goal, we need to guard ourselves from situations where we are dependent upon the opinion of others on whether or not we can achieve that. Make sure that you keep up the pressure to remove this language from the proposed changes to the Medicare guidelines!

If you haven't contacted your governmental representatives, you need to do so, whether you are on Medicare or not. These changes will affect your insurance, and it will drive the cost of prosthetic care higher than it already is. Take a stand, or plan on sitting down the rest of your life.

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