The Subtle Violence Against the Disabled : Health care: Budget crises offer one more ‘excuse’ to mistreat people who are seen as a problem; is euthanasia next?

It would be easy to dismiss the recent reports of violence against people with disabilities in Germany as an aberration, the work of a small band of neo-Nazi wackos, a uniquely German problem completely unrelated to the treatment of disabled Americans. It would be easy to do that--but it would be a dangerous mistake.

While physical violence against Americans with disabilities is more prevalent than most of us may want to believe, much of the problem for the disability community is subtler. Still, at least some of the forces prompting the violence in Germany exist here, too. Perhaps most powerful of these is the prevailing view that people with disabilities are a “problem” to be solved rather than a resource to be tapped in pursuit of solutions to the problems facing all of us.

The “problem” was made clear in the taunts of German teen-agers as they attacked a 46-year-old amputee: “Under Hitler you would have been gassed! You’re a waste of taxpayers’ money!”

That view is increasingly evident in this country as policy-makers respond to tight budgets. The scenario might unfold this way:

* Since health-care costs are skyrocketing, let’s severely restrict, if not eliminate, public and private coverage for “luxuries” like equipment, rehabilitation services and specialists who might really understand what it takes to deal with a disability or other chronic condition.

* Make it as difficult as possible for people with disabilities to get the help they need to live independently and stay out of nursing homes.

* Decrease oversight of nursing homes in order to reduce “regulatory burdens.” At the same time, cut payments to institutions that serve patients who are on public programs, so that even the most well-meaning staffs will become demoralized and behave accordingly. This should persuade a great many patients to prefer some other arrangement--like death.

* Make sure that programs for people with disabilities are designed and run by non-disabled “professionals” who regard their role primarily as that of administrator/caretaker for helpless victims. Corollary: If people with disabilities are permitted to have any say at all, be sure they know that they are expected to be humbly grateful for anything they get.

* Finally, support “humane” efforts to help people with disabilities to kill themselves when their lives become unbearable.

If all this sounds like the ravings of a paranoid radical, think again.

Example: A draft of Medicare’s new supplier manual states: “Durable medical equipment is covered when it is medically necessary for use in a patient’s home. Equipment and/or features that are needed for use outside the home . . . will not be covered.”

That’s a prison sentence for many of us with disabilities. The landmark Americans with Disabilities Act notwithstanding, Medicare’s approach segregates potentially productive disabled people at home, even though the right equipment would give them access to the kind of educational, social and employment opportunities they need to be truly independent.

And private insurers and managed-care plans often follow Medicare guidelines. All of this has chilling implications for the way in which national health-care reforms might deal with our most basic needs.

Example: In the great California Budget Showdown of 1992, Gov. Wilson initially proposed a 20% cut in In-Home Supportive Services, the state program that provides attendant care and other essential services.

Although disability rights advocates managed to limit the reduction to 12%, the action left many recipients reeling. Despite paper assurances that the cuts wouldn’t be made if they endangered beneficiaries or put them at risk of nursing-home placement, some counties gave out misleading or false information about appeal rights. (Ultimately, the state obtained federal funds to pay for restoring these services, but the way the program will operate in the future remains uncertain.)

The governor has proposed more cuts in other programs critical to Californians with disabilities. Fiscal pressures already have led officials to divert state money away from certain jointly funded disability programs and into the General Fund.

There’s more--much more. Whether intentional or not, parts of the scenario described above already are in place. That’s why many of us in the disability community are terrified by the prospect of a growing “right to die” movement that coincides with increasingly limited access to the support services that help us to live.

More often than not, what makes living with a disability unbearable isn’t the disability itself but the messages of helplessness and worthlessness that go with it. Those messages can kill.

Two weeks after the disabled man in Germany was attacked, he committed suicide. The note he left behind explains why: “Under Hitler I would have surely been gassed; maybe all these kids have a point.” He had bought the lie that disability equals worthlessness.

Unless public officials, business leaders, social service agencies and charitable organizations start treating disabled people as partners rather than as burdens, we will continue to be in jeopardy--and not only in Germany.