She's Deaf, You Pay The Price
A few words on the law of unintended consequences, and why I'm for small government, by the Freakonomics boys in New York Times Magazine:
A few months ago, a prospective patient called the office of Andrew Brooks, a top-ranked orthopedic surgeon in Los Angeles. She was having serious knee trouble, and she was also deaf. She wanted to know if her deafness posed a problem for Brooks. He had his assistant relay a message: no, of course not; he could easily discuss her situation using knee models, anatomical charts and written notes.The woman later called again to say she would rather have a sign-language interpreter. Fine, Brooks said, and asked his assistant to make the arrangements. As it turned out, an interpreter would cost $120 an hour, with a two-hour minimum, and the expense wasn’t covered by insurance. Brooks didn’t think it made sense for him to pay. That would mean laying out $240 to conduct an exam for which the woman’s insurance company would pay him $58 — a loss of more than $180 even before accounting for taxes and overhead.
So Brooks suggested to the patient that they make do without the interpreter. That’s when she told him that the Americans With Disabilities Act (A.D.A.) allowed a patient to choose the mode of interpretation, at the physician’s expense. Brooks, flabbergasted, researched the law and found that he was indeed obliged to do as the patient asked — unless, that is, he wanted to invite a lawsuit that he would probably lose.
If he ultimately operated on the woman’s knee, Brooks would be paid roughly $1,200. But he would also then need to see her for eight follow-up visits, presumably with the $240 interpreter each time. By the end of the patient’s treatment, Brooks would be solidly in the red.
He went ahead and examined the woman, paying the interpreter out of his pocket. As it turned out, she didn’t need surgery; her knee could be treated through physical therapy. This was a fortunate outcome for everyone involved — except, perhaps, for the physical therapist who would have to pay the interpreter’s bills.
Brooks told several colleagues and doctor friends about his deaf patient. “They all said, ‘If I ever get a call from someone like that, I’ll never see her,’ ” he says. This led him to wonder if the A.D.A. had a dark side. “It’s got to be widely pervasive and probably not talked about, because doctors are just getting squeezed further and further. This kind of patient will end up getting passed on and passed on, getting the runaround, not understanding why she’s not getting good care.”
So does the A.D.A. in some cases hurt the very patients it is intended to help? That’s a hard question to answer with the available medical data. But the economists Daron Acemoglu and Joshua Angrist once asked a similar question: How did the A.D.A. affect employment among the disabled?
Their conclusion was rather startling and makes Andrew Brooks’s hunch ring true. Acemoglu and Angrist found that when the A.D.A. was enacted in 1992, it led to a sharp drop in the employment of disabled workers. How could this be? Employers, concerned that they wouldn’t be able to discipline or fire disabled workers who happened to be incompetent, apparently avoided hiring them in the first place.
...So does this mean that every law designed to help endangered animals, poor people and the disabled is bound to fail? Of course not. But with a government that is regularly begged for relief — these days, from mortgage woes, health-care costs and tax burdens — and with every presidential hopeful making daily promises to address these woes, it might be worth encouraging the winning candidate to think twice (or even 8 or 10 times) before rushing off to do good. Because if there is any law more powerful than the ones constructed in a place like Washington, it is the law of unintended consequences.
sure, law of unintended consequence leads to some pretty poor outcomes... At the risk of letting cynical getting in my way, in a lot of cases the intentional consequence ISN'T what you think it is.
The intention is to be seen doing something.
The actual outcome is irrelevant as long as it isn't TOO bad, or is diffuse over a long period of time.
SwissArmyD at January 28, 2008 5:53 AM
Gee, the same liberal attitude causing unintended negative consequences in two of your articles in a row. You would almost thing that liberals are incapable of thinking two steps ahead.
Between this and the "Ethicist" article, we have liberal induced reasons why female, minority and handicapped people may be facing discrimination. Only this time, the discrimination is understandable,even tho it isn't really fair to unintended beneficiaries.
Smarty at January 28, 2008 5:56 AM
Unless you're the guy paying for some deaf chick's interpreter.
PS That woman, if she were ethical, wouldn't take advantage of this. I'd be embarrassed.
Amy Alkon at January 28, 2008 5:57 AM
"PS That woman, if she were ethical, wouldn't take advantage of this." Most of these laws were initially created to protect people. Now if you assume that being disabled causes one to be more ethical it work great. Stop the evil normal people from taking advantage of the disabled. Now all of this goes out the window supper fast if the disabled person is a lazy sack of crap that wants and expects to be catered to. But of course all disabled people are virtuous and us normals are lying stealing scum.
vlad at January 28, 2008 6:33 AM
I'm not connecting ethics with disability, merely commenting that I find her unethical for taking advantage of this.
Amy Alkon at January 28, 2008 6:39 AM
Also these laws drive the cost of interpreters through the roof. If you know that someone will have to pay your fee by law why should you charge a reasonable fee. Cause as we all know the interpreter is an evil unethical normal. Interpreters tend to make 30 to 50 and hour for spoken languages. How the hell else do they get to charge 120 per hour.
vlad at January 28, 2008 6:39 AM
"I'm not connecting ethics with disability, merely commenting that I find her unethical for taking advantage of this." I know I was just showing the skewed opinions I have seen. It appears to be fairly pervasive.
vlad at January 28, 2008 6:42 AM
$120 an hour? That's it, I'm ditching grad school and learning ASL ASAP.
Seriously, this is one of the down sides of the "deaf culture" mentality. The deaf people I know can read lips; they may need someone to repeat things occasionally, but they don't need interpreters. This woman, I presume, would need an interpreter if she wanted to purchase property or set up a small business. She effectively can't speak the language of those around her. If she really needs the help detailed here - i.e. she can only understand sign language for complex communication - then she's at constant risk of being taken advantage of. I'm certainly not advocating the elimination of ASL, and I'm aware that learning to read lips is not a simple process, but not being able to communicate with others effectively cuts you off from most of the human race. Which may explain why she doesn't seem to have, I dunno, friends or an SO who could spare an hour to come with her to the initial appointment and help translate. As the physician in the article pointed out, this woman is far worse off than she knows.
marion at January 28, 2008 6:42 AM
She effectively can't speak the language of those around her.
Amazing, huh? I might be lame at French, but I go to French class every week and listen to TV5 from France as I'm getting dressed in hopes of understanding people and being understood when I'm over there.
Amy Alkon at January 28, 2008 6:51 AM
This is old stuff. From June 7, 2006:(Are you able to obey this law?)
"Complicated laws like the ADA eventually hurt the people they were meant to help. The ADA has led many employers to avoid the disabled. One poll found that since the ADA was passed, the percentage of disabled men who were employed dropped. "Once you hire them, you can never fire them. They are lawsuit bombs," one employer said. "So we just tell them the job has been filled.""
Then there's the Exxon Valdez, captained by a "recovering" alcoholic, that ran aground in 1989 (before the ADA). Captain Hazelwood had successfully completed an Alcoholism Treatment Program and was subsequently given command of the Valdez. Had Exxon said "nope, too much risk, you're going to captain a desk" then Hazelwood likely would have sued for discrimination. Most companies at the time had drug and alcohol policies that forbade firing or demoting employees who sought treatment for substance abuse. After the ADA, Hazelwood's discrimination case was a certainty: (Remember The Exxon Valdez?)
"Reacting to the Valdez incident, and factoring in the generally high rate of recidivism in people with a history of substance abuse, Exxon took bold steps to prevent future accidents. Even though the company was aware that the ADA protected past substance abusers from discrimination, Exxon decided that these individuals posed too much risk to hold jobs that were both safety sensitive and were performed without much supervision--like the job of ship captain. For this small group of jobs only, Exxon instituted a blanket exclusion of individuals with a history of substance abuse.
In short order, Exxon's new policy embroiled the company in litigation with the EEOC that lasted many years and finally ended up in the 5th Circuit. In the 2000 case of EEOC v. Exxon USA Inc., the EEOC claimed that Exxon's across-the-board rule was illegal, even if it applied only to very limited job positions. The EEOC argued, first, that it would be difficult if not impossible to prove that in all cases a successfully treated substance abuser was an imminent threat (remember the earthquake example?) and, second, that safety-related qualification standards must meet the EEOC's direct-threat standard. The latter principle, in effect, imposes a higher burden on employers to justify safety-related qualification standards than other--potentially less important--job requirements."
So if you're Joe Employer why would you take the risk? You're much better off creating permanent Temporary Jobs and hiring through a Temp Agency. And never, absolutely never, hire anybody with a disability or that you think might have a disability.
Curly Smith at January 28, 2008 7:01 AM
A few years ago I was director of a local center for a national test prep company. We had a deaf student want to take our course, and we were required to have not one, but two interpreters. You see, our classes were three hours long and that was just too long for one interpreter to handle on their own. So for twelve classes at three hours each, we had two interpreters - all at our expense.
When I questioned whether we should do this (given that test prep is neither a right nor requirement to getting into med school), I remember a VP telling me to "spend whatever to took to get her through the course," as whatever it cost would be cheaper than the lawsuit.
Steve at January 28, 2008 8:46 AM
What? Can the woman not read or write? God, it has gotten ridiculous. Why should the doctor operate at a loss? As Marion says, she has no one in her life that could take an hour to help her with the doctor? No one? Not even one of these organizations that got the ADA passed and supposedly represent the disabled?
It's more of the nanny state syndrome. No one wants to take care of themself anymore. Every time I catch a bus (okay, I exagerrate but easily 1 out of 3 times) there's some moron rudely bothering me as I read (I guess they see middle-aged woman reading a book, that makes her like a librarian or something) to ask if their bus has been by, or do I know if such and such stops here, or what bus would they catch to go to XXX, or when does the next #2 bus get here. I have gotten so I act deaf (they're getting wise to this and tapping the arm or shoulder lately so I can't be the only one fed up enough) to ask. What the hell? If you can't pick up a bus schedule (which contains maps) easily available all over the damned town, call the vastly advertised, easily remembered phone number or visit the equally vastly advertised and rememberable web site, take your mommy with you next time because you shouldn't be out without her and I ain't her.
Donna at January 28, 2008 9:09 AM
Amy and the various posters make some good points. It's true that almost any law designed to protect a group can be abused. But should we throw the baby out with the bathwater?
I've had to invoke the ADA a few times in my career. I stutter. Can't do a thing about it, certainly not at my age. It doesn't mean I'm stupid, or ignorant, or insane, and it doesn't affect my job performance in the least. I'm not in sales and I don't have to give presentations (although I do fine with prepared, memorized material, like many stutterers). But I've had a few assholes want to get rid of me, or deny me promotions, because I stutter. Fortunately for me, a gentle reminder that the ADA has been found to apply to people who stutter always shuts them up right away.
L. McKenna at January 28, 2008 9:33 AM
I'm actually a big fan of the ADA as originally conceptualized, because I not infrequently find myself making use of ramps and elevators when I'm traveling with heavy bags. I've traveled in countries without ADAs, and schlepping stuff around is miserable. Yes, it's ALL ABOUT ME. Able-bodied me. Now, for people such as L. McKenna, and other hardworking disabled types, the ADA can be a godsend. The problem comes, as always, with the people wanting to game the system.
marion at January 28, 2008 9:59 AM
Some years ago I did a reporting project on the ADA, which required me to get out in the community and talk to quite a few disabled people, who ranged from deaf to blind to quadriplegic to those born with partial limbs. Of course I am a liberal fascist, but I was left with the feeling of overwhelming gratitude that I live in a country where we make accommodations for smart people like these, where we spend a little extra on a building to make the toilets accessible and doorways wide enough to push a wheelchair through without getting stuck, and yes, even where a deaf woman can cost a "top-ranked orthopedic surgeon" a whole $240 so that she can be absolutely sure what she's getting into when he operates on her knee.
Of course some people are going to game the system, as the human race is not perfect just yet. (P.S. Some libertarians are bitter scolds who lie awake at night worrying that a penny of their tax money might go to somebody who doesn't deserve it, but that doesn't make the whole philosophy bad.) However, I think if you bothered to actually stop a disabled person and get their thoughts on the matter, you might be surprised to learn that the law has, in general, made their lives immeasurably better while inconveniencing -- and costing -- the rest of us less than you'd think. And you might also learn that even with the ADA in place, their lives are not ones you'd envy, and are filled with daily inconveniences, humiliations and setbacks that would have some of you blowing the tops of your heads off with frustration, not that any of you are particularly angry or anything.
Or you can go on believing that lip reading is just something that deaf people are too lazy and obstinate to learn, unlike Amy and her French classes. Don't bother to sit down in front of your TV with the sound off and try to type a transcript of what the person's saying. Because of course it's only a matter of laziness, and if YOU were deaf, of course you'd learn lip-reading PDQ. And even if you were deafened tomorrow, having had hearing until this point in your life you'd probably do fairly well as a lip reader, keeping in mind that the average effectiveness of lip reading is around 30-50 percent, even for excellent lip readers. (For those born deaf, it's at the low end of that range, even after years of study.)
Which means you'd probably get the "fuck you" but lose "and the horse you rode in on." But it's not knee surgery or anything.
Nance at January 28, 2008 10:29 AM
Nance, I know two stone-deaf people who lip read and don't sign. They are treated like garbage by many (not all) other deaf people. You see, since they can't sign, they're not "authentically deaf" or some such tripe. There is a deaf subculture that is very abusive of any accommodation. That is, to say the least, unfortunate.
And all we're asking here is, when you create a law like this, what incentive did you just create? It could just as easily be applied to archaeology. Say you find an old Indian grave on your farmland. The right thing to do is report it. But if you do, you may lose the use of your land without compensation. What incentive did that kind of law create?
JohnAnnArbor at January 28, 2008 10:40 AM
And note, Nance, that the patient in question rejected written notes as a way of communicating.
JohnAnnArbor at January 28, 2008 10:42 AM
I actuallly taught myself sign language as a kid so I could communicate with deaf people. I don't leave the doctor's office until I'm sure I know what I'm getting. I think a deaf person can do that without making a doctor pay for her visit. Written notes might be a little more effort than just making the guy shell out -- but, in fact, she'd be more protected, informationally, then than a person like me, who just hears the stuff and then tries to remember.
Actually, come to think of it, I take notes when I go to the doctor, because I have ADHD, and don't want to forget anything they say. I guess I could, on these terms, force the doctor to hire a stenographer, but then, I'm not a liberal but a personal responsibilitarian.
Amy Alkon at January 28, 2008 11:14 AM
Nance,
To reiterate JohnAnnArbor, the person was not denied a way to communicate. The person was not denied treatment b/c of deafness.
Not to be Capt. Obvious, but this isn't TAX dollars paying for the patient's interpretors pre and post-op. It's Dr. Brooks himself.
Now, I'm glad you feel warm and fuzzy inside that you aren't an evil, penny pinching libertarian and support the redistribution of wealth against the will of others, but how is it moral (notice I didn't say "fair") that the doctor has to foot the bill?
I do support provisions to help the handicapped lead lives as close to normal as they can. A blind family friend gets picked up by a MA-funded van which takes her to the doctors or the store. Sometimes friends take her, but if they can't their tax dollars ensure that she can be fairly independent. This is a good thing in my opinion.
For you to assume you understand another person's financial situation (it's as if you think the doctor can easily afford the net financial loss of having her as a patient) is arrogant and, in all likelihood, an inaccurate interpretation of the situation. Maybe he can afford to pay several grand for an interpretor for one patient but at what point do we say "hey, maybe we shouldn't force charity on people, cause, uh, he just foreclosed on his house."
It's not up to any of us to burden individuals w/ that. We don't get to make those judgments for random people. Maybe as a society we can come up with something and maybe we can ask people to be more reasonable in their demands (have her read - I can type nearly as fast as I talk...it's a fine way to communicate). It's one thing to help those w/ totally exhausted options through public service and it's another to force a doctor to deal w/ unarmed robbery.
Gretchen at January 28, 2008 11:27 AM
"I take notes when I go to the doctor, because I have ADHD," Nance, so here you have a disabled person showing how they compensate for their disability without making anyone else's life worse. Much to my own surprise ADHD and ADD (the version that I have) are both covered by the ADA. You wouldn't believe how much shit you could get away with especially in academia under the ADA.
With regards to lip reading: you only catch part of the conversation if the person you are talking to is ignorant and speaks fast or turns their head. Try listening to an American from a different part of the country. If their dialect of American English is sufficiently different you will catch about 50% of it.
vlad at January 28, 2008 11:39 AM
I'm going to second Amy. Many times I don't understand some of the lingo doctors use. Asking the doctor to type out his findings and course of treatment, etc. is reasonable. He could hand this to her or email it ahead of the follow up visit. She could read it before showing up. This allows her to Google some of the stuff to understand what is going on and prepare questions. I've yet to enter a doctor's office where the examination room doesn't have a computer in it. Typing in Notepad or Word is reasonable.
Gretchen at January 28, 2008 11:40 AM
Kaiser also has e-mail. My doctor does a lot of stuff via e-mail. Saves office visits, and if I ask her a question, I have a record of that question and her reply.
If I were deaf, I'd ask a doctor if I could e-mail him or her with any clarifications I needed after the appointment.
Amy Alkon at January 28, 2008 11:45 AM
If I used any of the specific rights I have under the ADA due to my ADD it would give me an unfair and unreasonable advantage over "normal" people. So under certain circumstance I have to work harder at things then "normal" people. Well stupid people have to work hard at certain things, should being just plain dumb give you access to supports that level the playing field?
vlad at January 28, 2008 11:47 AM
Look, I'm not saying deaf culture is the bomb. It's not -- it's ghettoizing yourself. At the same time, I understand why deaf people feel so strongly about it, and if you take the time to learn about it, you'd understand too. I also understand why they object to things like cochlear implants for children. I don't agree, but I can certainly empathize.
What I don't understand is why you want to take what *seems* to be an abuse of the ADA as a reason to question the whole law. As you may know, many deaf people don't communicate well in writing. It goes back to the sort of early education they got, but if you've ever used a TTY machine to have a phone conversation with a deaf person, you know that translating their ASL-shaped communication into writing is a dicey proposition. "You go barrel cracker?" might mean "Want to go to the Cracker Barrel with me?" or "Did you go to the Cracker Barrel for lunch?" or "Did you see that barrel? It had crackers in it." Like lip-reading, written communication -- for *some* deaf people --relies heavily on context and comfort with the person they're "talking" to.
I just Googled "idioms in ASL" and found this blog:
http://deaf-tea-time.blogspot.com/2007/07/paper-and-pen.html
Take note of the comments, and pay attention to what a wide range you see there -- not only of opinions, but of mastery of written communication. It doesn't seem out of line for a deaf person, preparing for surgery, to make sure she has the best possible information she can get, i.e, via an ASL interpreter. The ADA requires "reasonable accommodation," and that doesn't strike me as unreasonable.
As for the doctor fretting over what all this would cost in follow-up visits, etc., maybe he could try this radical strategy: Talk to his patient. Tell her he's concerned about the costs of continued ASL interpreting, and would she be comfortable communicating another way for follow-up visits, or whatever. Most disabled people can be pretty accommodating when they have to be, because after all that's what their whole goddamn life has been, for most of them -- accommodating themselves to a world that wasn't made for them.
As for the unintended consequences of the law, well, every law has them. It's easy to pluck out individual examples and say, "Poor doctor, having to pay an interpreter," but what about the disabled people who can now pee in a public bathroom without having to show their ass to the rest of the room? People who can see a hockey game without having to be carried to a seat? Who can use a public park because there's a ramp down to the fountain instead of a flight of steps? Isn't that worth something, or is the doctor's vote the only one we count?
One final note: It's not just the disabled who benefit from accessible facilities. It's old people, young mothers with strollers, maybe you if you have to have knee surgery and hobble around on crutches for a few weeks. I once stood in a high school gym that was so hostile to anyone who couldn't climb steps (and very steep ones) that kids in wheelchairs could only watch basketball games from the doorways. Hell, some of the players' grandparents couldn't go, because they couldn't get up the steps to the seating. It's hard for me to see the remodeling that fixed it as anything but a good deal for everyone.
Nance at January 28, 2008 11:50 AM
What I don't understand is why you want to take what *seems* to be an abuse of the ADA as a reason to question the whole law.
Because the law does not seem to contain any mechanism to prevent these abuses, and typically, one hears only about a fraction of the abuses of *any* law.
It's hard for me to see the remodeling that fixed it as anything but a good deal for everyone.
I am taking it that you didn't have to pay for said remodeling? I typically find anything that I don't have to pay for to be a good deal as well. I'm not saying that remodeling isn't worth it - just that you're discussing the ADA as though the cost of its accommodations don't have to be considered. There's no free lunch. The cost of accommodations always must be considered. No one's saying that the idea that motivated disabled people should be given some legal protection is a bad one. We're doing a cost-benefit analysis of the way the current law is written.
marion at January 28, 2008 11:58 AM
Well, the high school was in my school district, so yes, I did pay for at least part of it. And how, exactly, do you do a cost-benefit analysis of a law that makes life easier for a whole class of people? "There aren't enough gimps in the county to justify the extra $6 million the new, accessible coliseum will cost?" Don't the gimps' tax dollars get a vote?
Here's another anecdote I remember from my story, and I'll leave you with this, as I'm sure it will make some heads explode: One of my sources was a man born with incomplete limbs -- one normal leg, one partial leg, one arm of about three-quarter length but with an incomplete hand, and one arm that ended around the elbow. He was a fantastic person, with bountiful confidence and an absolute insistence that the world make a place for him. So he's supposed to be in a friend's wedding, and he goes to the tux-rental place to be measured. The pants aren't a problem, as he wore a prosthesis on his half-leg, but the jacket was impossible to alter without cutting the sleeves beyond just the hem -- one would have to be lopped off at the elbow, another just below.
The tux shop said, "Sorry, we won't do that." He told them they were required to under the ADA, and literally quoted them chapter and verse. They tried to broker a compromise where they'd pin the sleeves up, which wouldn't work because he needed the ends of both limbs free for eating, etc. Finally they folded and sacrificed a jacket for him. I asked him how he felt about that. (I figure the people here would say he should have bowed out of the wedding rather than cost the tux owner so dearly.) He said he felt like any man would, who could expect a tux-rental place to make the suit the right length. And then he pointed out this was a rental tuxedo, not YSL couture, made of cheap polyester and designed to be partied in. He said he figured the store had some replacement costs built into their pricing structure, what with the tendency for groomsmen and prom dates to abuse the product. He just considered the loss of the jacket to be the equivalent of a 16-year-old barfing tequila and spaghetti all over their pants, and left it at that.
Nance at January 28, 2008 12:23 PM
As for the doctor fretting over what all this would cost in follow-up visits, etc., maybe he could try this radical strategy: Talk to his patient. Tell her he's concerned about the costs of continued ASL interpreting, and would she be comfortable communicating another way for follow-up visits, or whatever.
Right. Except that if I were this doctor, and I had suggested once already that maybe the interpreter weren't necessary, and she had informed my staff that it was my responsibility to pay under the ADA - I'd be *very* worried that this woman would take a suggestion that I didn't much care for paying for an interpreter after the surgery as trying to shirk my legal responsibilities. I'd be afraid she'd sue - after all, she wasn't real interested in working something out with me on that first visit.
jenl1625 at January 28, 2008 12:23 PM
"I also understand why they object to things like cochlear implants for children. I don't agree, but I can certainly empathize."
Oh yeah? I DON'T empathize. Arguing that disabled children should be denied access to a technological innovation that could reduce the impact of the disability and open a wider array of opportunities to these children flies in the face of the most basic notions of individual liberty.
Deaf persons collectively attempting to maintain the existence of their unique deaf culture is a laudable example of the exercise of personal liberty and also an excellent example of robust civil society. However, attempting to maintain the viability of "deaf culture" as a cohesive segment of society by denying deaf children the opportunity that cochlear implants might provide to participate more fully in the wider culture is a monstrous abuse. It is a selfish and narrow attempt to subvert the personal autonomy of the children in question to undermine the integrity of their families - all in the name of the purely private, personal interests of the current members of this community. This view deserves neither sympathy nor empathy.
Dennis at January 28, 2008 12:40 PM
Dennis, many deaf people don't see themselves as disabled -- only different. They reject CIs for the same reason most black parents would reject a magic pill that could make their children white. Sure, the kids'll go further in a world where they don't have to deal with racism, but at what cost to their identity?
I don't agree, but I don't think it's worth fighting over, as the vast majority of deaf children are born to hearing parents, and they overwhelmingly opt for the CI, at least if they have decent health insurance.
Nance at January 28, 2008 12:52 PM
Dennis, many deaf people don't see themselves as disabled -- only different.
I call BS. They can think that all they want, but that doesn't change that they're wrong. It is not a simple difference, like skin color or facial structure. It is a lack of a fundamental way of sensing the world.
Know any deaf commercial airline pilots? Soldiers? Pretending that not being able to hear is NOT a limitation might be politically correct, but it isn't logical.
JohnAnnArbor at January 28, 2008 12:57 PM
Nance,
Your tone, your careful reasoning, everything...I just want to say I think your comments have been exemplary.
Just one thing to add to the following:
"He went ahead and examined the woman, paying the interpreter out of his pocket. As it turned out, she didn’t need surgery; her knee could be treated through physical therapy. This was a fortunate outcome for everyone involved — except, perhaps, for the physical therapist who would have to pay the interpreter’s bills."
My (totally non-deaf) sister-in-law is currently recovering from major, if fairly routine, full knee replacement surgery. The evaluations this has involved have been extraordinarily complex and detailed - and she has - with the greatest sympathy and backing from her wonderful consultants - been forced to accept the advice to proceed, only after accepting unusual expert qualifications about various possible outcomes, with just one knee at this time.
This single replacement operation is not ideal - it has taken marathon discussions.
(She is borderline early for the particular procedure, which has caused - counter-intuitively - extra complications about the advisability of intensive physical therapy on its own.).
It is possible some commenters here may not be aware that knee surgery can be an unusually complicated, if informed, gamble.
And is possibly something that merits unusually detailed and comprehensive patient understanding.
Jody Tresidder at January 28, 2008 1:37 PM
Nance that individual you mentioned is an ass. Here's why. If the tux is too badly damaged to be cleaned or mended by some kid puking tequila and pasta on the tux the place keeps the security deposit. The security deposit is the built in replacement cost. If he has different body type issues he should have bought a tux. The all would have been good. He demanded by threat of law suite that he be personally catered to. Using your logic Michal Jordan would have the right to have a tux tailored to his size for the same fee one of us average people would. Yet he's not covered by the ADA yet.
vlad at January 28, 2008 1:37 PM
"Your tone, your careful reasoning, everything...I just want to say I think your comments have been exemplary." No one is questioning that she should have an interpreter, that's up to her. The question is should the Doctor pay for it?
Any surgery is complicated and the patient should go in as well informed as possible. What makes you think that the interpreter would help. Even if the terms for knee surgery are found in the ASL Medical dictionary the patient would have to learn the signs looking at pictures any way. The doctor is burdened with the cost the benefit is tenuous. Also the computer animation of how the surgery is performed. I can't imagine any interpreter doing a better job in any language than a computer rendering of the operations.
vlad at January 28, 2008 1:53 PM
"They reject CIs for the same reason most black parents would reject a magic pill that could make their children white."
What a preposterous analogy. Being black is not a disability, while being deaf clearly is, no matter how some may try to recast that reality. Additionally, it is not the parents that object to the implants, but outsiders with no right whatsoever to second-guess or otherwise interfere with parents in the rearing of their children, deaf or otherwise. In postulating such an absurd position, you merely demolish the very position that you "empathize" with.
You illustrate the incoherence of your own position by conceding that "the vast majority of deaf children are born to hearing parents." Yet, it is the judgments of this "vast majority" of parents of deaf children whom these self-appointed crusaders for the deaf community want overruled.
That many deaf people don't see themselves as disabled is quite beside the point. In what way does this justify an outrageous attempt to force other people to be "different" like themselves? Arguing for the denial of cochlear implants to children is nothing but a naked attempt to force others to conform to a preconceived standard regardless of the will of the children or their families. So much for respecting "differences."
Activists for the deaf community arguing for a ban on cochlear implants is no different than the Amish or Orthodox Jews or the Shakers or any other self-segregating segment of society arguing that the state should help them to preserve the viability of their communities by using force to prevent people from leaving them.
Nance, your interest in the ADA is commendable, but you make yourself ridiculous by attempting to defend the indefensible.
dennis at January 28, 2008 2:03 PM
"What makes you think that the interpreter would help"
Because the deaf woman seemed to think one would in the circumstances? (That is, I don't assume it was all just a fun waste of time!)
Jody Tresidder at January 28, 2008 2:04 PM
Jody: Fair point, She wanted an interpreter. If she was willing to pay for an interpreter there would have been no questions here. If the doctor agree to work with her as he did using anatomical models etc. why should he pay for the interpreter.
vlad at January 28, 2008 2:14 PM
Vlad,
Yeah, I know.
(I just think that deaf people and similar probably make so many invisible, silent, endless accommodations in daily life - I've never thought it's really a slackers' charter on the whole, though sure - abuse happens - that sometimes they are allowed to stick their necks out and say "hey, YOU fucking pay for fucking once...". So - I am hopeless!
But thanks for being decent about it!)
Jody Tresidder at January 28, 2008 2:30 PM
Vlad,
P.s. We all love our non-deaf sister-in-law - the one with the complicated knee(s) very much - but this marathon of debate, treatment advice and Big Decisions - has driven us all half mad. I genuinely think knees are very, very dodgy, and the treatment possibilities a real challenge to sort out - even before you get into the new "gender specific" replacement parts, the latest trend!
Jody Tresidder at January 28, 2008 2:35 PM
I'm not defending the indefensible. If you'd simmer down a minute, I'm just trying to point out that other people see things differently from you, and that perhaps if you tried to look at it from their perspective, you might learn something. (By the way, I didn't come up with the deaf=black comparison. It's one deaf people themselves frequently make. Go yell at them. See if it does any good.)
No one in the deaf community is trying to "force" anyone to not get CIs for their deaf children. They're merely speaking up (with their hands) to make their opinions heard, and yes, many of them are very vehemently opposed. But as yesterday's discussion about circumcision should have revealed, parents have the final say over their children's medical procedures. So it's a losing battle for them, and I think more of them are starting to realize that.
If you really are interested in learning more about this -- I suspect you aren't -- you really need to read about ASL. It's not just the alphabet on your hands; it's a different language. It has its own grammar, idioms, etiquette, etc. And just as many languages seem to encompass cultural concepts unique to its speakers, so does ASL. Written and spoken English, or signed exact English, is not ASL, and ASL is not those languages. ASL, more than anything, encompasses and sustains deaf culture.
In the meantime, you might try watching this, by another group that wants to bring music, yes music, to the deaf:
http://youtube.com/watch?v=hKnF9CCYQPQ
Nance at January 28, 2008 2:39 PM
It's not just the alphabet on your hands; it's a different language. It has its own grammar, idioms, etiquette, etc. And just as many languages seem to encompass cultural concepts unique to its speakers, so does ASL.
But Nance, doesn't this mean that ASL is not the best way to communicate technical information? To what extent does the ASL interpreter (no matter how professional) color the information the doctor is trying to convey? Maybe this is reduced by having a professional ASL interpreter rather than a friend or family member, but still - if the doctor uses a term I don't know, I can ask him to explain or I can write it down and go look it up. If the doctor uses a term I don't know, and the ASL interpreter used an idiom to convey something similar to the idea, I may not realize that I don't know what the doctor meant . . . .
And either way, if ASL is so cultural, rather than just a means of mitigating a disability, why must the doctor pay for it? Does the doctor have to pay for a Spanish translator?
jenl1625 at January 28, 2008 3:33 PM
I'm sorry, but does this woman know no one who can both hear and sign? Does she have no hearing family and/or friends who could have gone with her to the doctor for no cost???
I qualify under the ADA for several medical issues. I've never had to mention the ADA to my boss because he is smart enough to know what qualifies and what doesn't. The expense isn't huge. In my case my boss had to shell out less than $100 to hang blinds in my office because I can't be exposed to sunlight, at all. I think if we're talking about someone who can't get a job they are qualified for because the office has no wheelchair access then it needs to be fixed, but issues like the Tux thing, that guy needed to allow them to pin up the sleeve in question well enough that he could still use the arm, to insist they destroy a product they will then loose money on simply because he wanted to throw a lawsuit in their faces is just wrong.
Kimberly at January 28, 2008 3:41 PM
Promise this will be my last comment on this (maybe!) because I'm sounding like a liberal bore even to my own ears - b-b-but...Kimberly?
You wrote:
"I'm sorry, but does this woman know no one who can both hear and sign? Does she have no hearing family and/or friends who could have gone with her to the doctor for no cost???"
Maybe she has - and maybe she's "used" them many times for similar, similarly important situations? Maybe she values a certain level of privacy, sometimes, for which friends/family are not always ideal?
I think this can be a hitch when you have a chronic to-be-endlessly-coped-with congenital condition.
Yeah, yeah - I know, we're talking an important principle of general personal responsibility here!
Still, maybe she had her good reasons...
(will shut up now).
Jody Tresidder at January 28, 2008 4:12 PM
1. Nance: "If you'd simmer down a minute, I'm just trying to point out that other people see
things differently from you"
Dennis: I am perfectly aware that other people see things differently from me.
2. Nance: "and that perhaps if you tried to look at it from their perspective, you might learn something."
Dennis: Actually, Nance, it is you and those you speak for who are not looking at it from "their" perspective. Why don't you ask your friends out to ban cochlear implants to consider the point of view of the parents of deaf children? Or of the deaf children themselves? I am presenting a point of view. THEY are the ones who think it right and just to override the wishes of parents trying rear children, and to deny children access to efficacious treatment for a major disability, treatment that could vastly increase the life opportunities for those children, and who seek this for narrow, self-serving reasons.
3. Nance: "No one in the deaf community is trying to 'force' anyone to not get CIs for their deaf children."
Dennis: Wrong. They HAVE advocated a government ban cochlear implants. And a government ban is, in fact, an act of force - as the government will use FORCE to carry out that ban if necessary (hence the phrase "ENFORCE a ban on coclear implants").
4. Nance: "By the way, I didn't come up with the deaf=black comparison. It's one deaf people themselves frequently make. Go yell at them. See if it does any good."
Dennis: You gave it currency by not only repeating it, but by stating your "empathy" with it. As to "yelling" at them, they haven't entered the fray here, you have.
5. Nance: "They're merely speaking up (with their hands) to make their opinions heard"
Dennis: They're doing more than that, they are trying to enlist the state in their crusade to decide what is best for other people's children. Of course, they have every right to do this, but they cannot expect me to sit idly by while they do it.
6. Nance: "...and yes, many of them are very vehemently opposed."
Dennis: They have a constitutional right to their opinions, but that doesn't change the fact that they are meddlesome busy-bodies trying to interfere in the affairs of other people's families. It also doesn't give them a right to a pass from criticism.
7. Nance: "parents have the final say over their children's medical procedures."
Dennis: Not if it was up to them. And don't believe for a minute that the state is not capable of intervening in the rightful decisions of parents to please a noisy special interest group.
8. Nance: "If you really are interested in learning more about this -- I suspect you aren't...."
Dennis: You have no idea what I am or am not interested in. But I'll tell you one thing I am interested in: Extending the maximum possible opportunities to every person, including deaf children who might benefit from cochlear implants. I am also interested in parent's rights to rear their children without undue intrusion by the state.
I'll "simmer down" when everyone in America recognizes the autonomy of every other person and respects the integrity of every family, and views people as individuals and not as nondescript members of groups.
dennis at January 28, 2008 4:28 PM
One last comment, my last I promise:
My views cut both ways. I would also oppose the state attempting force cochlear implants upon children whose parents do NOT want it.
dennis at January 28, 2008 4:35 PM
I have found this a very interesting discussion, but my thinking is that in the question of who should pay for this why has nobody brought up that maybe the health insurance should pay for this?
I mean clearly her health insurance must know that she is deaf when they agreed to cover her. Why don't they have to pay for her proper medical coverage? Isn't that what she's supposedly paying them for?
In reality the deaf woman is not the doctor's responsibility. Paying her doctor's bills is partly the responsibilty of her insurance (at least in theory) and if this is part of her bill then the insurance should be providing some at least some of it.
I mean maybe she should have a higher co-pay or some kind of different coverage scheme than the non-deaf, but why does the insurance company go completely unmentioned in this discussion?
flighty at January 28, 2008 5:06 PM
Flighty, good point about insurance.
Dennis, I've been Googling for an hour and I can find no serious effort to ban cochlear implants for hearing children. I can find lots of fervent opinion about it, but not a single bill introduced in a legislature to outlaw the procedure for children. In fact, as I suspected, the attitudes of even the culturally deaf are changing.
Warning: Wikipedia; the usual cautions apply:
As the trend for cochlear implants in children grows, Deaf-community advocates have tried to counter the "either or" formulation of oralism vs manualism with a "both and" approach; some schools now are successfully integrating cochlear implants with sign language in their educational programs. However, some opponents of sign language education argue that the most successfully implanted children are those who are encouraged to listen and speak rather than overemphasize their visual sense. Significantly, deaf individuals have a high rate of illiteracy due to the phonetic nature of the western writing systems; it is thought that cultivating the auditory senses will help a hearing impaired child to avoid this problem[citation needed]. However, others (mainly Deaf people who have been through education in decades past) feel that the high levels of relative illiteracy is mainly due to profoundly deaf children being taught orally, despite being sign language users and not being able to fully understand speech. Oral education in the past, though, was vastly different from the approaches today, which have the benefit of hearing with cochlear implants. Previous generations relied heavily on lipreading; a fairly high percent of today's implanted person can often can hear well or only have moderate hearing loss, and depending on the individual, no lipreading whatsoever.
Nance at January 28, 2008 5:51 PM
Dennis - your comment at 4:28...loving you right now. A lot.
Gretchen at January 29, 2008 5:36 AM
"I mean maybe she should have a higher co-pay or some kind of different coverage scheme than the non-deaf" The problem is that with the ADA she can not by law be asked to pay more, it's discrimination. So due to the ADA someone has to pay for it but no additional money has been set aside to do so.
vlad at January 29, 2008 6:48 AM
With all due respect to your example re: the school ball games, Nance, you might not feel the cost of adding the ramps but odds are elderly homeowners on fixed incomes (i.e., the very grandparents you tout as it benefiting) are. It may wind up, in the neediest cases, causing them to lose their nearby homes and thus being less able to see their grandkids play. Tell me again, what was the point?
I think it's disgusting that anyone would deny a deaf kid an operation enabling them to hear. I'd go one step farther than Dennis and say the government should interfere, just as it does for immunizations say, and intervene. What's next? The blind community saying no you can't let that kid have the cornea transplant. They won't be special any more. Comparing correcting a physical abnormality to skin color is comparing apples to oranges.
The guy renting the tux and forcing the company to destroy a jacket is an asshole plain and simple. I hope someone finds some bullshit cause to sue him for everything he has. Turnabout is fair play. (Not really but it fits here.)
Donna at January 29, 2008 7:45 AM
Personally as far as choclear implants I'm not sure the government should force them to be implanted, however if a person who is eligible refuses them they should be denied special services. If you went to refuse a cost effective solution for reasons of personal animosity why should I pay for it. The movement against implants is a small but noisy minority.
vlad at January 29, 2008 7:56 AM
I have a 2 year old son who has had a hearing loss since birth. We went through the entire cochlear implant candidate program* but ended up not needing to go to the extreme measure of doing the implant surgery.
We were involved in our local Early Intervention program, but I closed his case because I didn't like the philosophy of our local program. My son loves his daycare, but my caseworker actually suggested it would be better if I quit my job, went on welfare, and stayed home with him so he could always be with someone who knows sign language. (I was given the option of having a sign interpreter attend daycare with him everyday, at taxpayer expense)I refused, and I pulled him out of early intervention.
I did my own research into speech and language development and came up with our own exercises we do at home. At our latest speech assessment, he scored as normal in spoken English and was deemed bilingual in English and ASL. All at no cost to the taxpayer (the speech therapist I fired cost the county $77/hour) I want my son to be able to live independently.
(Of course, Early Intervention is a good thing, but it has to be applied mindfully)
The woman in the original article was done a misservice by her education if she cannot be independent, but she should work to sharpen her written English if that is the issue.
*The cochlear implant surgery is not a fix for deafness. It requires lengthy retraining of the brain, or it is just a waste. Our health insurance company required that my husband and I be interviewed and my son psychologically evaluated to see if we were good candidates worthy of the $50,000 investment of a cochlear implant, because we would have to follow up on all the auditory training. We were approved, but it turned out to be unnecessary.
physicist at January 29, 2008 12:25 PM
i work at a hospital and we are required to provide interpreters to patients when we don't speak oh, spanish, hmong, polish, whatever. i'm pretty sure insurance covers that cost. couldn't prove it, though, so if someone says i'm wrong, they're probably right. but in any case, i wonder why it wouldn't be considered the same thing to provide an interpreter for ASL. but in any case, patients who cannot cover any part of their bill, for whatever reason, are responsible for the entire cost - including spanish/hmong/whatever people being responsible for the payment of interpreters. without the help of the ADA. it seems rather unfair to me that not only is there the the difference that the interpreter for the spanish speaking person is paid for by insurance but not for ASL, but also unfair that the deaf community - which apparently is "different", not disabled - has the ADA to back them up to make doctors pay out of pocket for things other people have to pay on their own. also rather hypocritical of the deaf community, to say they're "not disabled", but run to the american DISABILITIES act to free them from the bills that would otherwise be their responsibility. maybe i should appeal to NOW to pay my gynecologist, you think it would work?
kt at January 29, 2008 7:32 PM
Thanks, physicist, that does clear a lot up about the implants and shown me that I need to know more. Cudos to you for doing so well by your little boy and cudos to him for achieving what he had to work quite hard for. Good going.
Donna at January 31, 2008 9:19 AM
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