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Increasing Access to Prosthetics: A Beginner's Solution
By David McGill, Chairman of the Board, Amputee Coalition of America (ACA) "In the beginner's mind there are many
possibilities, but in the expert's there are few."-Shunryu
Suzuki
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David McGill |
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In case you're wondering, this is not a compliment
to experts. I have spent the last decade of my life performing
research, drafting appeals, and reading legislation, all of which
have somehow resulted in my gaining the title, "insurance expert."
And yet, with all my legal training and subsequent experience in
and with the insurance industry, I have consistently found that
this "expert status" is a double-edged sword. Too often, I have
rejected solutions to problems, or failed to see them altogether,
because my "expert" mind reflexively filtered out unfamiliar
concepts. It is only when I have dropped all pretense of being an
"expert" that I have been able to do my most innovative and
creative work. Similarly, as an above-knee amputee who receives
prosthetic care, I have learned that the best prosthetists are
those who can access their "beginner's mind." They constantly
modify their socket designs, tinker with their alignments, and
utilize new prosthetic components because they are never satisfied
with their patient care.
Prosthetic Coverage: Insurance Issue
But beginner's mind or not, I can't draft a useful appeal, and a
CP can't deliver a prosthesis, when the client's insurance company
either does not cover prosthetics, or does so with an annual cap so
low that it renders coverage illusory. And the "experts'" solution
to this problem-"let's roll back the Medicare payment freeze"-is in
my view naïve and potentially dangerous because it fails to
address the bigger underlying issue: access to appropriate
prosthetic care. After all, fee schedules don't mean anything when
the insurer won't pay more than $2,500 per year for a new
prosthesis.
Legislative Solution
As chairman of the Amputee Coalition of America's (ACA's) Board
of Directors, I am extremely proud to be involved with an
organization that is an admitted "beginner" when it comes to this
issue. The ACA has worked with healthcare providers, industry, and
consumers to formulate a solution that only a beginner would have
the audacity to suggest: the passing of legislation to mandate that
every amputee with health insurance have access to
appropriate prosthetic care.
Support the Action Plan!
Response to this proposal has been overwhelmingly positive. And
yet, support for the Action Plan for People with Limb Loss (APPLL)
has been absent in one important and fundamental way: dollars
donated. Maybe people think that their donation won't help. Perhaps
they believe that legislation can't work. Or they can't conceive of
investing in a project that will take years to complete. My
response?
- Every donation, no matter how small, helps.
- It can work, as several states already have statutes
in place, while others have legislation pending.
- If APPLL succeeds, the donations made today will secure a much
better financial tomorrow for prosthetists, while at the same time
benefiting their patients.
Sometimes, being an expert limits our vision and binds us to the
past. We need to start thinking like beginners and live in a world
of many possibilities, rather than one where only a few
exist.
David McGill is the chairman of the Amputee Coalition of America's Board of Directors and the executive director of A Step Ahead Prosthetics & Orthotics in Hicksville, New York. He is a member of the New York State Bar, and an above-knee amputee. 
Table Of Contents - August 2005
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