The Healthcare Reform I Would Love to See

Awhile back, I posted this status update on Facebook:

*Insurance rant*: So our insurance company denied coverage of J's feeding therapy, saying it's not medically necessary. First of all, when did the definition of "medically necessary" get so stringent that it doesn't automatically include teaching a tube fed kid to eat by mouth? And second, how short sighted is it to deny coverage for the one service that is really helping us move closer to getting off the feeding tube, while continuing to pay for all the much more expensive services that maintain the feeding tube (GI doc, nutritionist, weight checks with ped, home health care supplies, etc.)? Banging my head against the wall. But also looking forward to appealing this decision, as fighting insurance companies is what i do for fun these days .

Six months later, we are still fighting to get occupational therapy covered.  We've done an informal appeal, a formal appeal, a review at the state Bureau of Insurance, and now we're exploring our additional options.  The problem is this:  except in rare cases, private insurance companies do not cover therapy services for kids over age three.  (I think our case fits as one of the limited circumstances -- the insurance company, so far, disagrees.)  So the health care reform I would like to see is this:  private insurance companies should cover physical therapy, speech therapy, and occupational therapy for developmental disabilities and other medically necessary situations.  

Of course I'm mostly focused on getting Joshua the feeding therapy he needs, but this is an issue that goes far beyond our family.  The CDC announced earlier this month that 1 in 68 children in the United States is diagnosed with an autism spectrum disorder.  That's a HUGE number of kids who could greatly benefit from PT, ST, OT, and other types of therapy -- but if their family has private insurance, then the family will probably have to pay for the therapy out of pocket, which can add up to thousands of dollars per month.

The benefits of these therapies is huge.  They improve quality of life and functionality in big ways. They provide kids with the tools to move around independently, communicate, eat and drink, and generally better use all the parts of their body.  This helps the kid, the kid's family, and it ultimately helps society because you have more people who are able to do more things, so health care costs go down.  (I'm probably totally butchering this section, so if you are a therapist and want to jump in on the comments section and better explain why you are awesome, PLEASE DO.)

There are several systems in place to provide kids with therapy:  Early Intervention provides therapies  until kids turn age 3; the school system provides therapies after age 3 (but only if they are related to education, only during the duration of the school year, and often the therapy is provided in a group setting rather than one-on-one); and Medicaid covers some therapy services outside of school (but many kids do not qualify for Medicaid, and some therapies are not covered by Medicaid).  These programs are great and they provide much of the coverage that is needed.  But this leaves some huge, gaping, holes:  like a child with a feeding tube who has 4 doctors saying that he needs feeding therapy to learn to eat -- but the child is over age 3, learning to eat is not related to education, and the child is not eligible for Medicaid - so no coverage.

Thanks for letting me step on my soapbox and wave my fists in the air.  A blog is probably not the best way to effect policy change, but it made me feel better to write about it this afternoon, so thanks for reading.

Ban Bossy?

I've seen several blogs lately about Sheryl Sandberg's campaign to ban bossy.  Some of them respectfully dissent (I loved this one); some of them rage against the campaign (did not care for this one).  So now I'm adding my two cents.

The reason for the "Ban Bossy" campaign is to try to encourage young females to be leaders.  I'm all for more female leaders.  My problem is with the idea that bossiness is the character trait that makes a great leader. The definition of bossy is "given to ordering people about; overly authoritative; domineering; highhanded, officious, dictational; overbearing, abrasive".  Are these the qualities we want to cultivate in our future leaders, male or female?  Even if you use the definition of bossy that the backers of the campaign probably intend - something like "assertive, opinionated, and expressive" - I question whether these are the most important traits in either being a good leader or putting yourself in the position to become a leader.

Here are the three traits I've consistently seen in the best leaders in my life (whether they were male or female):

1.  Exceptionally competent - Great leaders are really good at what they do.  Whatever it is you do, if you do it with excellence and care, you will stand out.  This may sound super obvious, but it's surprisingly rare.  If you're excellent at what you do, then you won't need to be the loudest person in the room - you will earn people's respect, promotions, etc., by doing a good job.  Teddy Roosevelt said it the best:  "Speak softly but carry a big stick."

2.  Hardworking -  Great leaders work hard, and that's often how they cultivate their exceptional competence.  This doesn't necessarily mean that the leader has to be the first one to work in the morning and the last one to leave (although it certainly can look like that) - it means that they attend to their tasks with focus and diligence; that they keep practicing a skill or working on a problem until they get it right; and they don't just show up when the spotlight is on, they put in the hours doing tedious preparation so that they can perform well in the spotlight.

3.  Relate to those they lead with kindness - Great leaders treat the people they are leading with dignity, respect, and kindness.  If there is a problem, they start with an attitude of "how can i help fix this".  They take responsibility before they lay blame.  They listen well, they give praise and encouragement frequently, and they care about the welfare of the people they are leading.  This doesn't mean that there is never conflict or never a need for correction, but it will be received better if the followers know that the leader cares about them and wants them to succeed.  A kind leader makes people want to follow him or her.

These are the qualities I think we should be seeking to cultivate in our future leaders, both boys and girls.  So how about a campaign for #competent #hardworking #kind?