I stumbled upon a blog post in the New York Times that claims that the ADA, by making it costlier to see patients with disabilities (specifically, deaf patients who need interpreters), will result in fewer and fewer doctors accepting patients with disabilities. The author specifically noted that Medicare only reimburses 15-25% of the interpreter fees. Basically, since the doctor is not ‘profiting’ off the deaf patient, the author assumes that the doctor will (and is able to) refuse to treat the patient. Upon these tenuous assumptions, the author asserts that the ADA has the unintended consequence of encouraging discrimination. The author is implicitly telling us that the ADA is not worth its cost.
Another thing that I found the comments quite fascinating. I practically had to shield my eyes from the vim and vitriol that the commenters spewed. Some asserted that the deaf patient should have been placated by communication via writing. If “these” deaf folks are not satisfied with writing, these commenters said that the patient should pay for his or her own interpreter. Others merely derided the ADA as expensive and useless. The underlying assertion of many conmenters is that providing interpreters for a deaf patient is unreasonable if the doctor does not profit per every visit. Of course, there was some useless prattle about what a burden people with disabilities are on society and blah, blah. On the other hand, there are some quite good comments who repeat some points that I am going to make.
First, the author assumes that the doctor may and will reject a deaf patient because of the costliness of the patient. Let me remind the author about two things: the Hippocratic oath and the ADA. Medical ethics recognize that doctors fulfill a public service. There’s a reason why the medical profession is so heavily regulated in comparison with, say, retail. Doctors provide an essential service for society – health care. One line of the modern Hippocratic oath applies: “[w]hatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice…” Of course, the oath is not legally binding, but the oath outlines appropriate professional conduct. Denying access to a patient because of his or her status (deaf or otherwise disabled) should never be condoned or encouraged.
The author also assumes that the ADA allows a doctor to refuse service to deaf patient. Hello, Title III? Has the author even read the ADA? I think not. Title III prohibits all public accommodations (that’s you doctors) from denying access to people with disabilities (that’s you, deaf patients) unless it is an undue burden (not so much here). If a doctor tries to refuse service to d/Deaf patient because of his or her disability, that doctor is begging to be sued. Doctors may come up with contrived excuses. Such a practice, however, will inevitably lead to a near-total absence of medical service for d/Deaf patients. If all doctors (assuming, of course, they are big bad doctors who ignore their ethical duties) somehow got around the ADA and refused service to all deaf patients. No medical service! Why should d/Deaf folks bother with insurance then? Why should society bother funding Medicaid for d/Deaf folks then? Regardless of your stance towards health reform, most of us can agree that if we pay insurance (either ourselves or via taxes), we should get some degree of health care. In the infamous words of Homer Simpson, D’oh!
There’s also the argument that it is unreasonable for the doctor to shoulder the cost of interpreters. Such an argument assumes that the doctor should be able to profit from every single patient on every single visit. Um, no. Most doctors have more than one patient, and unless he or she has a disproportionate number of deaf patients, his or her practice should make an overall profit based on the rest of the patients. So, what’s the problem? The doctor can’t make an extra few hundred dollars? Cry me a river. If the doctor has a high number of d/Deaf patients (as in certain Rochester or Washington DC metro areas) then it would behoove him or her to staff a qualified interpreter. Doctors see people with medical problems, and guess what? People with disabilities can have medical problems too!
Many commenters argue that deaf patients should ‘mitigate’ the costs by communicating via notes or hiring their own interpreters. Putting the ADA aside, forcing d/Deaf patients to bear the costs (effort and/or monetary) is a terrible policy. First, it is not effective to communicate solely via written notes. Notes cannot capture the repartee, complexity and rapidity that spoken/signed language can . Second, we live in a society where discrimination based on disability is rampant – in employment, public accommodations and social context. Should society force an underemployed d/Deaf person to bear the financial costs of social discrimination? I would hope that we have evolved past that mindset.
The comments to this article rubbed me the wrong way. It seems to me that the current recession, the worst since the Great Depression, has brought out an ugly side of humanity. People’s total lack of compassion. I have been seeing more and more criticism of socially progressive policies such as affirmative action and inclusion of people with disabilities into mainstream society. A lot of the criticism is based on the me-me-me policy. If society (or doctor or school, or whatever) spends a bit of money accommodating a person with disability, then it takes away money from able-bodied persons. How these people stomp and yell about this injustice. These who label people with disabilities money-siphoners assume that non-disabled people somehow have a ‘moral right’ to society’s resources, and people with disabilities don’t. The dearth of compassion unnerves me – true inclusion seems impossible with that kind of mindset. Spare me the Darwinist argument. We, as a civilization, are supposed to evolve past the rough-and-tumble life of the jungle. The unfortunate thing is that people with disabilities are a lot more accommodating of people without disabilities than the other way around.
To sum it up, the ADA should not be used as an excuse to discriminate. The ADA does establish an effective barrier against discrimination, in terms of medical service. The real problem is that people refuse to accept accommodations as a social duty that we all bear.