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Division of Aging and Division of Aging and DHS Divisions General Eldercare Locator
Age with Dignity East Arkansas Western Arkansas
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This
column appears in the February 2008 edition of Aging Arkansas,
Lazy and Insulting Last month, an article entitled “Freakonomics: Unintended Consequences,” by Stephen J. Dubner and Steven D. Levitt, appeared in the New York Times Sunday Magazine. It got my blood boiling. The alleged purpose was to advise the winning Presidential candidate to “think twice (or even 8 or 10 times) before rushing off to do good” lest the laws designed to help will cause more harm than good because of unintended consequences. Nothing wrong with that advice. But Dubner and Levitt infer that the Americans with Disabilities Act is an example of a “do-good law” that has backfired. The rationale for such a sweeping conclusion? One anecdotal story and a study they present as fact that was later proved controversial, if not outright wrong. I find this lazy and offensive. Dubner and Levitt write: “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 (ADA) 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 ADA 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 ADA, 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 ADA affect employment among the disabled? “Their conclusion was rather startling and makes Andrew Brooks’s hunch ring true. Acemoglu and Angrist found that, when the ADA was enacted in 1992, it led to a sharp drop in the employment of disabled workers. How could this be? Employers, concerned that they wouldn’t be able to discipline or fire disabled workers who happened to be incompetent, apparently avoided hiring them in the first place.” What the authors don’t say is the study they reference was published in 2001, and generated much debate and further research. In 2004, researchers at Cornell University concluded, “There was a decline in employment, but it was not a consequence of the ADA.” Columbia Professor Michael Dorf hits the nail on the head: “At the end of their essay, Dubner and Levitt admit that not all laws have perverse consequences. Yet they leave the clear impression that they think the ADA does and inevitably must. Both claims are highly controversial. Dubner and Levitt present them as unarguable fact.” Presenting something as fact that is highly controversial or not true is troubling. Especially when it appears in a publication, like the New York Times, that the public perceives as reliable. In addition to misrepresenting a study, look at some of the “facts” they write about: “an interpreter would cost $120 an hour, with a two-hour minimum, and the expense wasn’t covered by insurance. 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.” Where did the $120 figure come from? While it is possible someone might charge $120 an hour for an interpreter service, most charge less than half that amount. Dubner and Levitt’s math doesn’t add up, either. They calculate the surgeon would lose more than $180 by deducting the $240 interpreter service from the $58 insurance payment ($240 less $58 = a loss of $182). When was the last time you spent an hour in a doctors examining room? Let me rephrase that, when was the last time you spent an hour in a doctor’s examining room with the doctor? Their calculation implies the $58 payment represents an hour of service. Insurance companies don’t reimburse by the hour, they reimburse by the visit. While the initial visit might take an hour, it is highly unlikely the eight follow-up visits would take as long. Based on my experience, 15 minutes is more realistic. That would equal $232 per hour, which would not be unusual, since an orthopedic surgeon can easily gross $354,000 per year. As Dr. Brooks is a “top ranked orthopedic surgeon in LA,” one might assume his gross income is closer to $500,000 per year. What about the patient? The authors conveniently leave her side of the story out. If I was facing surgery, I would want more than notes — especially those written in a doctor’s handwriting. Yes, at 15 words a minute, it takes more time for Stephen Hawking to communicate with a speech synthesizer than someone with typical speech. Just as an interpreter is an added cost, so then is the extra time it takes Hawking to “speak.” Health care providers no doubt “lose money” because of this. Should Hawking, then, only be allowed to listen when in the presence of a health care provider? What about the other aspects of the ADA they omit? Like the fact that restaurants, offices, courts, parks, airlines, information technology, telecommunication services, housing, schools, transportation, polling places, etc., etc., etc., are all dramatically more accessible? Or that accessibility benefits the non-disabled who push kids around in strollers, or the elderly who can take an elevator instead of stairs, or business executives who roll around their lap tops and LCD projectors? Or veterans returning from the Middle East? Let Dubner and Levitt live in a silent world, or try navigating life with only the partial use of one hand. Let Dubner and Levitt experience the world with a closed head injury or the lack of vision. Let them confront a business, medical and social service world with few bright spots; more typically, one that ranges from ignorant to uncaring about people with disabilities. Maybe then they wouldn’t misrepresent facts or leave the impression that laws like the ADA do more harm than good. Division of Aging and Adult Services |
