Health & Social Policy

A Healthy Life Can Cost an Arm and a Leg

“Mommy, look! That man has one leg, what happened?” I hear this so often when I walk around in shorts. I have a prosthetic leg, or a robot leg as my kids call it, and as if that wasn’t enough to make it stand out, I have a giant burnt orange Longhorn and the word “Texas” written across it in 4-inch high letters.  I usually respond with something witty like “I didn’t eat my vegetables growing up” or “This is why you look both ways before crossing the street.”

The other day I found myself speechless. An elderly gentleman who recently lost his right leg to diabetes asked me how much my leg cost and if my insurance covered the whole thing. I lost my leg to a grenade during Operation Iraqi Freedom and the Veteran’s Administration pays for all my prosthetics, so I had no clue.  He explained to me that his health insurance would only cover up to $5,000 and he didn’t have the money to make up the difference, so he was wheelchair bound.

I wish I could say that I went home, researched prosthetic limbs and got involved. But like most Americans, because his problem didn’t impact me directly—even though it resonated with me more than most people—it soon faded from my mind. It took the earthquake in Haiti and the images on the news for me to think seriously about how much a prosthetic limb costs and then responses to my previous op-ed on the subject before I seriously looked into the issue in the United States.  I can honestly say that I am appalled with what I discovered.

A Wall Street Journal article from 2008 states that most health insurance companies only cover $2,500 to $5,000 in prosthetics or other “durable medical devices,” and then only once per individual per lifetime. Up to $5,000 per person per lifetime is in no way close to being adequate to cover even one basic limb for a below-the-knee leg amputee. A prosthetic device for an above-knee amputee costs upwards of $60,000. Prosthetic arms are a whole different category, which run from the basic “hook” version for a few thousand, to the highly sophisticated robotic hand, which costs in the hundred thousand dollar range.

So what is the big deal? Why is this a concern that affects the broader community apart from the amputees and their families? In other words, why should health insurance companies do more? If they are unwilling, then why should Congress step in? The greater population needs to understand that a prosthetic device is more than just a “robot leg.” It is a device that allows someone who lost a limb due to diabetes, a motor vehicle or industrial accident, birth defect, shark attack or whatever accident to have access to a normal life. It allows them access to the basic human right of “the right to work,” to provide for their families and to be a participating member of society. By covering the whole cost of a prosthetic limb, health insurance can raise amputees out of wheelchairs to their feet and to a productive life. They take people off Social Security disability and make them workers who can contribute to Social Security.

For the gentleman in the wheelchair at H-E-B, Section 222 (b) of the recent health care legislation includes “minimum services to be covered,” which lists prosthetics and “other durable devices” under subparagraph 10. Does that mean that the American taxpayer will have to pick up the tab on his prosthetic?

Honestly, I don’t know, I haven’t read the whole bill nor do I know where the funding is suppose to come from, but I am sure the social and communal benefits well outweigh the costs. Why should someone be denied the right to be a working member of society and a full life because health insurance companies are unwilling to cover them?

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