California Pays Steep Prices for Wheelchairs

His new wheels suit Mark Beckwith just fine.

The motor purrs, the computerized steering turns on a dime, the front-wheel drive eats up bumps and the seat tilts at a touch.

The sticker price was $36,933 -- more than that of a C-Class Mercedes-Benz.

But this is no German luxury car. It's a wheelchair made in Sweden, customized in the United States -- and paid for by California's health program for the poor.

"Thirty-seven thousand dollars may seem expensive," said Beckwith, a lifelong muscular dystrophy victim with little use of his limbs. "But this chair is the difference between me being active and productive and lying in bed watching Jerry and Oprah."

In the last five years, the cost of supplying wheelchairs to disabled, elderly and needy Californians has more than doubled. Last year alone, the California Medical Assistance Program, or Medi-Cal, bought 16,723 chairs for $66.1 million.

Increased demand helped push wheelchair spending upward, and so did technological advances that made chairs more sophisticated and pricey.

But state officials have made only sporadic and largely futile efforts to control what they spend on the most expensive piece of medical equipment Medi-Cal buys. They have repeatedly bent to political pressures and jettisoned their own cost containment rules and initiatives.

While the federal government and smaller programs in other states cut better deals, the $29-billion Medi-Cal system failed to use its enormous buying power to bring down wheelchair spending. Industry experts say California may be the only big state to consistently pay manufacturers' suggested retail prices for chairs that cost from hundreds of dollars to tens of thousands each.

Beyond the purchase price, Medi-Cal also failed to effectively regulate the number and types of chairs supplied to recipients. The program has not updated its list of authorized chairs and prices for 17 years.

Wheelchairs represent freedom to the thousands of people who need them. But they also illustrate the sometimes wrenching collision between the government's mission to help vulnerable people and its obligation to balance the budget and weigh competing priorities.

When California enjoyed relatively sound finances, the clash was less consequential. Attempts to rein in Medi-Cal spending on wheelchairs were beaten back by a coalition of wheelchair users and dealers and, in a booming economy, they faced far less competition for state dollars.