One other thing about how brain dead that Medicare's thinking is about paying for programs like Proloquo2go + an iPhone/iPod Touch. Assistive devices in general aren't as "pocket ready" as iPhones and therefore, aren't as accessible. One photography teacher years ago told me that a camera isn't worth anything if you keep a lens cap on it. You aren't ready to shoot. An assistive device that isn't easy to transport isn't as assistive as it could be.
User adoption is a big problem for devices like this, especially with kids who already have hangups about looking or feeling different. I would think that a child with a program like this might end up wanting to use it more simply because its on a device all the other kids are carrying and can be used for other things like music or videos. And from a Medicare cost standpoint, it's obviously cheap. Why should this be an administrative problem?
Where did the government get the no-bid contract for an 8000-dollar, text-to-speech only solution?
Ladies and Gents, I present to you a fleeting glimpse of your grandchildrens' future, in dollars, being spent this very second on inane acquisitions like this one.
Here's a perfect example of why government should NOT be in charge of deciding what doctors are trained to decide. Do you really think Obama will be your personal health advocate?
I go to bat for my patients PERSONALLY each and every day I work, and I will spend 4 hours that I'm not going to get paid for to make sure one patient gets the care they need to save their life.
Will nObama do this for you? Will a lawyer do this for you (4 hours they KNOW they're not getting paid for???). Would a f***ing PLUMBER do this for you?
I would Rx this iphone app, AND the iphone, to most of my autistic kids. Not only the app is useful, but the iphone interface is uniquely suited to really augment their daily life in a really positive way and improve their overall QOL.
Honestly, the people that really need the expensive device couldn't use the iPod/iPhone version anyway. There's a real good chance they won't have the hand eye coordination to hit the small icons on the screen.
While I agree with the principle of the article... let's flip it around and see why the government is so paranoid about this.
Imagine if they started buying general purpose systems for everyone. They buy good, but inexpensive computers that don't have good support for the disability community.
You can't go to one provider for support - you have to go to Apple if the iPhone fails, the software maker if the software fails - if you can figure out which is which... and so on.
Then the Republicans and anti-government people jump in and start yelling 'entitlements' and how the government is giving poor people 'expensive toys' the rest of us can't afford and so on...
The someone's voicebox is found to have porn on it - and the yelling gets louder and louder...
Ironically, this article itself is kind of why things are the way they are. It's easy to look at something without any surrounding context and make it into a big moral point... but the very act of doing that creates the moral point one complains about.
I find this article really rather funny - if we turned the situation on its head, and Medicare did decide to pay for the iPhone for disabled people, we would see articles like "Want a free taxpayer-paid iPhone? Disabled people only!" or something, and see mainstream media outrage over taxpayers paying for gaming and media devices just because they can also do something for the disability.
I agree that $8000 is outrageous, but speaking as somebody who has had a family member use one of these dedicated TTS devices, you clearly don't understand the need that these address, or the rigors that they are put through.
The devices simply HAVE to be single purpose. They can't do anything else. A lower functioning individual with developmental disabilities has no use for the other features on the phone, and if there was a complicated process for accessing the TTS features, then it defeats the purpose if they don't know how to get to it.
Additionally, my sister was prone to throwing her TTS around when she was upset. See how long an iphone/touch lasts under those conditions. Miraculously, she only went through a couple of them, because they were sturdily built.
@Scott Jackson: I'm not gonna say that it's a simple matter, by any means. I've had only limited interactions with autistic and mentally retarded folks. I can tell it's not an easy thing to deal with.
I think the reason this gets people charged, though, is not that "the iPhone can do it". Though, throwing the collective Apple lust into this argument is probably the worst way to handle it. The real issue, though, is that, as you said, $8000 *is* crazy.
DynaVox, the company that makes this stuff said in the NYTimes article that they charge so much (as much as a 2000 percent markup) because they essentially have to make the software from scratch. And that may be so. Niche software usually costs much more than popular software, admittedly. But if there is that big of a gap between competing products (and they are competing), and the hardware is much the same, one has to ask if there's a better way serve those who need it.
I don't know the solution, but in my experience, there's always a way to save money. This may be one place to look.
@OCEntertainment: The other issue driving this cost, as others have mentioned in other comments, is that this isn't a consumer device. Meaning, it's not going to sell a lot... so the margins have to be understandably higher to make sure everybody involved gets paid.
Also, the capabilities of touchboards haven't changed much over the years, even though the hardware and technology driving them has. My sister's first board was basically a digital recorder with a large grid of buttons. There's no reason that the vast majority of people using them need much more than this, and that technology is a lot cheaper now than it was 20 years ago. So I have the feeling that these companies upgrade the hardware to keep the costs up, and that's another contributing factor.
but really, most of these boards are "push the button, play a word/phrase"
How hard can it be? Why even bring the iphone into it?
It might be the smarter choice. It's hard to say. There point is allowing a device that can do other things invites fraud. It means that people who don't really need this will claim to in order to get a free iphone/ipod touch/whatever.
Between the added cost of fraud and investigating said fraud, they *might* end up saving money by just going with the far more expensive option. I'm not saying it does, just that it sounds possible and so I wouldn't want to jump to conclusions.
I'm sure its better anyways, the iphone has an awful small screen and so a proper tablet-sized computer likely is a bit easier to use.
"We would not cover the iPhones and netbooks with speech-generating software capabilities because they are useful in the absence of an illness or injury."
OK, Don't buy the hardware. Just cover the software. That's the part that turns the general-purpose metal into what the patient needs!
10/06/09
Ppppffffff. Everyone knows the future of health care is... The Nozzle
10/06/09
Who's got the biggest melanoma of them all?"
10/06/09
10/06/09
10/06/09
10/06/09
09/15/09
09/15/09
User adoption is a big problem for devices like this, especially with kids who already have hangups about looking or feeling different. I would think that a child with a program like this might end up wanting to use it more simply because its on a device all the other kids are carrying and can be used for other things like music or videos. And from a Medicare cost standpoint, it's obviously cheap. Why should this be an administrative problem?
09/15/09
Ladies and Gents, I present to you a fleeting glimpse of your grandchildrens' future, in dollars, being spent this very second on inane acquisitions like this one.
09/15/09
I go to bat for my patients PERSONALLY each and every day I work, and I will spend 4 hours that I'm not going to get paid for to make sure one patient gets the care they need to save their life.
Will nObama do this for you? Will a lawyer do this for you (4 hours they KNOW they're not getting paid for???). Would a f***ing PLUMBER do this for you?
I would Rx this iphone app, AND the iphone, to most of my autistic kids. Not only the app is useful, but the iphone interface is uniquely suited to really augment their daily life in a really positive way and improve their overall QOL.
Why dontcha y'all vote for ME next time around??
09/15/09
09/15/09
Imagine if they started buying general purpose systems for everyone. They buy good, but inexpensive computers that don't have good support for the disability community.
You can't go to one provider for support - you have to go to Apple if the iPhone fails, the software maker if the software fails - if you can figure out which is which... and so on.
Then the Republicans and anti-government people jump in and start yelling 'entitlements' and how the government is giving poor people 'expensive toys' the rest of us can't afford and so on...
The someone's voicebox is found to have porn on it - and the yelling gets louder and louder...
Ironically, this article itself is kind of why things are the way they are. It's easy to look at something without any surrounding context and make it into a big moral point... but the very act of doing that creates the moral point one complains about.
09/15/09
09/15/09
09/15/09
09/15/09
The devices simply HAVE to be single purpose. They can't do anything else. A lower functioning individual with developmental disabilities has no use for the other features on the phone, and if there was a complicated process for accessing the TTS features, then it defeats the purpose if they don't know how to get to it.
Additionally, my sister was prone to throwing her TTS around when she was upset. See how long an iphone/touch lasts under those conditions. Miraculously, she only went through a couple of them, because they were sturdily built.
You just don't get it.
09/15/09
I think the reason this gets people charged, though, is not that "the iPhone can do it". Though, throwing the collective Apple lust into this argument is probably the worst way to handle it. The real issue, though, is that, as you said, $8000 *is* crazy.
DynaVox, the company that makes this stuff said in the NYTimes article that they charge so much (as much as a 2000 percent markup) because they essentially have to make the software from scratch. And that may be so. Niche software usually costs much more than popular software, admittedly. But if there is that big of a gap between competing products (and they are competing), and the hardware is much the same, one has to ask if there's a better way serve those who need it.
I don't know the solution, but in my experience, there's always a way to save money. This may be one place to look.
09/15/09
Also, the capabilities of touchboards haven't changed much over the years, even though the hardware and technology driving them has. My sister's first board was basically a digital recorder with a large grid of buttons. There's no reason that the vast majority of people using them need much more than this, and that technology is a lot cheaper now than it was 20 years ago. So I have the feeling that these companies upgrade the hardware to keep the costs up, and that's another contributing factor.
but really, most of these boards are "push the button, play a word/phrase"
How hard can it be? Why even bring the iphone into it?
09/15/09
Between the added cost of fraud and investigating said fraud, they *might* end up saving money by just going with the far more expensive option. I'm not saying it does, just that it sounds possible and so I wouldn't want to jump to conclusions.
I'm sure its better anyways, the iphone has an awful small screen and so a proper tablet-sized computer likely is a bit easier to use.
09/15/09
OK, Don't buy the hardware. Just cover the software. That's the part that turns the general-purpose metal into what the patient needs!
09/15/09