Re: stump vs. residual limb: I’ll use whatever term the amputee prefers, as I think personal preference in these cases trumps political correctness.
I used to work for the Evil Insurance Empire, in the research department (meaning, the department that reads and analyses medical research, not a department that does such research) which was right next to the department that made recommendations for what should and shouldn’t be covered based on medical effectiveness. (Decisions on cost effectiveness were done elsewhere.)
The consensus was overwhelming that for working-age adults the C-leg was superior to prior types of prostheses. Now, there were some people who chose less sophisticated alternatives (for example, there was a gent who liked to go duck-hunting and the C-leg’s electronics would never have survived such a wet environment so he used a more primitive leg that, for the environment, worked better) and that was fine, but particularly for above-the-knee amputees the more advanced (and expensive) limbs were better.
Here’s the stupid thing: even the best and most comprehensive medical plans, the “Cadillac” insurance, only paid for a new limb ONCE at anything like reasonable coverage (say an 80/20 split). ONCE. Even though, as Klaatu says, these devices have only a limited lifespan. And the more active the person the shorter that span because the limbs got more use with highly active people and were more likely to be subjected to environmental damage. All the rationales for paying more initially for a C-leg - better mobility, fewer injuries from falling, more health from being more active, etc. would seem to justify paying to replace one when it wears out but apparently no one was willing to think that far.
Which brings me to the term “mindset”. I think, due to most of the people in the decision-making area being 50+ and able-bodied themselves (indeed, I recall one manager saying she’d never want someone with a disability in her department because they wouldn’t be able to handle it. What? It’s a desk job!) they still think of amputees as helpless old crippled people, view a C-leg as a “luxury” or something for the military to supply to young wounded soldiers (in other words, not their problem), and were utterly convinced that the vast majority of amputees were elderly frail diabetics who were so debilitated by age and disease that they wouldn’t benefit from a prosthetic anyway. A wheelchair was good enough for them, and not one of those fancy ones, a generic one should do just fine because didn’t those people have home care attendants anyway? If they weren’t already in a nursing home.
Being outside that mindset, and far too uppity for my own good in a corporate environment like that, I once did ask the “recommend coverage” people what they didn’t recommend replacement coverage. The first was response was that for most amputees they’d be dead from their disease before needing a replacement (I have no idea if that’s true or not, but it shows the mind set that amputee=sick old fart beautifully). OK… but what about the young/active amputees? Oh, she said, after 5 years or so they’d settle down, be done chasing after their young children, and wouldn’t need such a fancy limb anymore. Uh-huh. (Because young amputees won’t have more children because they don’t have sex or something? What?) Or, she added, their incomes would have risen because that usually happens as people get older (nevermind job discrimination - like her own department not wanting a cripple, right?) and anyhow, it was the amputee’s responsibility to save up for a replacement. If they wanted to replace their worn out prosthesis with a $50,000 limb then it was on them to save up $10,000 a year (or whatever) towards a new one. What if they didn’t make enough money to do that? Well, then, they need to get a better job! (Nevermind job discrimination…) Her attitude was that if you were young (meaning under 60) and disease-free and lost a limb you must have been doing something stupid and why should anyone but you have to pay for your recklessness? You were lucky to get the first one!
Aside from mindsets within the insurance industry, what so often gets lost is that it is not the insurance company defining what’s in your health plan it’s your employer who does that. And a plan that covers only 10% of the cost of new limb will have a lower premium than one that covers 80%, especially if there is an amputee on staff who will eventually utilize the benefit. The vast majority of people don’t care because they aren’t missing a major body part and cruise through life without imaging that it could one day happen to them.
For other medical insurance craziness: why isn’t dental coverage lumped in with general medical care? (Yes, I know it’s based on historical practice, that was rhetorical) Why are hearing aids almost never covered? Isn’t hearing an important sense?
From my viewpoint, a society has an interest in maximizing the ability of citizens to function but then I’m a crazy person in favor of universal health care, too.
