Locked out.

Note to Medicaid patients: The doctor won't see you.

The Wall Street Journal reports on another way that people with disabilities are being sent to the back of the line. A growing number people with disabilities are losing access to health care or facing monumental delays as doctors across the country increasingly refuse to accept Medicaid patients, reports Vanessa Fuhrmans. Link here.

The story, which focuses on Michigan, raises the following points:
-- Straining under higher costs, Medicaid has been freezing or slashing fees to doctors. Doctors say Medicaid payments now do not even cover their costs.
-- A recent report from the non-profit Center for Studying Health System Change found that nearly half of doctors polled said they had stopped accepting or limited the number of new Medicaid patients.
-- Specialists are exiting the system at a higher rate than primary care physicians.
-- Delays in receiving treatment are leading to serious health consequences and costly emergency care, patients say.
-- The dwindling number of doctors who accept Medicaid patients undermines some presidential candidate proposals to broaden health-care coverage by expanding Medicaid eligibility.

PWD* reacts to prenatal screening

The Washington Post runs letters in response to "Haunting Echoes of Eugenics." Bridget Brown, a woman with Down syndrome, compares widespread prenatal screening and termination with genocide directed toward people with disabilities. Her words:

I have a full and wonderful life, and the world needs to know that I do not "suffer" from Down syndrome. Most people I know with disabilities have full and productive lives. My heart breaks when I think that I might be part of the last generation of people with Down syndrome. The world will never again benefit from our gifts. But I will continue to hold hope for people with disabilities. And I will pray for all the people who think we don't have the right to live.

Ms. Brown's letter goes to the heart of the ethical conundrum surrounding universal prenatal screening, which Michael Sandel powerfully explores in "The Case against Perfection: Ethics in the Age of Genetic Engineering" (just out on Harvard University Press). Is total reproductive choice completely beneficial to society? Ms. Brown's experience doesn't lead her to that conclusion. As a person with a disability* (PWD), she encounters daily the uninformed and negative preconceptions people have about her and the quality and value of her life.

Sandel explores the issues around reproductive choice and views it as a mixed blessing. He worries that individuals who are granted this kind of control over their children will come to be held accountable for their children's perceived flaws. The implication: that those who screen and terminate will come to be seen as "responsible" parents, thus justifying a society that lacks empathy and compassion for the lives of those who differ from accepted norms.

Taken together, the aggregation of our private, individual decisions seems to reflects a deep and undiscussed discomfort with those who are different. The implicit message we seem to be sending is that while ethnic diversity is valued and supported in our society, genetic diversity is not. How comfortable would any of us be explaining that paradox to Ms. Brown?

Further reading on this topic: "Confessions of a 'Genetic Outlaw'", by Elizabeth R. Schlitz, in Business Week, July 20, 2006.
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It's worth noting: this is not a discussion about Roe v. Wade. It is a discussion about the paucity of informed consent in prenatal screening, and the collective social effects of individual decision-making.

College honors

So how's it been to attend college classes as a student with a disability? For Andrew Cormeir, who gave one of the student speeches at a Cape Cod Community College honors ceremony this week, the college experience has been a lot like it would be for everybody else. He made friends, worked hard, learned a lot. And if his pervasive developmental disorder slowed him down just a bit, Andrew took it in stride.

"It stinks, I know," he said of his disability with a grin as the audience roared its approval. "It might take me longer to think of things, but when I do I know what I'm thinking about."

Andrew was among scores of students who received certificates from the college's Project Forward Tuesday in a commencement ceremony that could only be described as joyful. Speaker after speaker lauded the group’s spirit, energy and zest for learning. “It’s not hard to be your strongest supporter,” said CCCC President Kathleen Schatzberg, who praised the students’ work in the community. “Your achievements have been enormous.”

It was a day for focusing on abilities, not disabilities, as cap-and-gown-wearing students gave speeches, sang, danced and high-fived their way across the stage to the delight of family, friends and college administrators. Pomp and circumstance gave way to tears when a student group sang “How could anyone ever tell you (you are anything less than beautiful)?” In all, almost 60 students earned recognition for their work in such areas as child care, mass communications, retail and culinary arts.

Project Forward, which serves students from all over the country, is one of a growing number of college programs that are designed to meet the needs of students with significant learning difficulties. Started 19 years ago, the program has grown steadily and will expand to welcome 115 students this fall. It focuses on developing employment skills with the goal of helping students live as independently as possible. This year it placed 67 students in internships with area businesses.

For more information on postsecondary programs for students with disabilities, see Thinkcollege.net.