Attending to Inclusion: People With Disabilities and Health‐Care Reform

Every 15 years or so, the topic of health-care reform re-emerges.For many, including those who work in health care, the subject can trigger indifference, cynicism, and fatigue.No doubt the issue is political, technical, tedious, interminable, contentious, and mind-numbing in its potpourri of facts and figures.Arguments about runaway costs, egregious social inequities, and the need to protect competition and the entrepreneurial spirit of Americans will inevitably be brushed off, spiffed up, and rolled out again.Lines will be drawn; political interests and advocacy groups will storm Washington and the airways, and encourage their constituents to write their congressmen.In the end, many citizens will feel disempowered and powerless to exert influence.Yet, for those of us who work with people with disabilities, the need to stay involved in the fray is critical.With an ever-aging population and growing numbers of people living with disabilities and chronic illnesses, the need to plan for comprehensive rehabilitation and long-term care is paramount.As costs, outcomes, and quality indicators become the currency driving reform, rehabilitation professionals need to help shape and lead this discourse.But how can we best do this?To simply respond and advocate for favorable reimbursement changes for rehabilitation services in the context of health care reform is not enough (eg, prospective payment system 75% rule, bundling, etc).One mark of medicine as a profession is the imperative to put self interest aside in favor of the needs of our patients and of society at large-particularly when they are in conflict.A good starting point for a health-care reform discussion may be to ask the following questions:• What are the most pressing issues for people with disabilities in the context of health-care reform?• What evidence do we have that the policies, treatment models, and programs we advocate for in rehabilitation medicine meet the standards of the Institute of Medicine's 6 pillars of quality (eg, a system that is safe, effective, patient-centered, timely, efficient, and equitable)?• Rehabilitation medicine is a leader in promulgating the biopsychoecological model of medicine.Is physical medicine and rehabilitation (PM&R) adequately attending to its full ranges of dimensions in health-care reform (eg, the need for personal assistance services, caregiver supports, accessible environments, etc)?Should it be?If not, why not and who should?• Finally, are rehabilitation and disability researchers collecting the best information and deploying our limited research resources to address these most pressing questions?To probe these questions, I have invited 3 experts from different perspectives and disciplinary backgrounds to share their perspectives: Mary Lou Breslin, co-founder and senior policy adviser for the Disability Rights and Education Defense Fund, a leading national disability rights law and policy center;