The story of Ms. Whitaker’s two organ donations — the first from her mother and the second from her boyfriend — sheds light on a Medicare policy that is widely regarded as pound-foolish. Although the government regularly pays $100,000 or more for kidney transplants, it stops paying for anti-rejection drugs after only 36 months.
The health care bill moving through the House of Representatives includes a little-noticed provision that would reverse the policy, but it is not clear whether the Senate will follow suit. The 36-month limit is one of several reimbursement anomalies — along with inadequate primary care payments and incentives that encourage unneeded care — that many in Congress hope to cure. …
Bills have been introduced in Congress since 2000 to lift the 36-month limit and extend coverage of immunosuppressant drugs indefinitely. They have never made it to a vote, largely because of the projected upfront cost; the Congressional Budget Office estimates that unlimited coverage would add $100 million a year to the $23 billion Medicare kidney program.
But the cost-benefit analysis would seem obvious. The most recent report from the United States Renal Data System found that Medicare spends an average of $17,000 a year on care for kidney transplant recipients, most of it for anti-rejection drugs. That compares with $71,000 a year for dialysis patients and $106,000 for a transplant (including the first year of monitoring).
There are actually several levels of stupidity at play here, some of which the Times’ report doesn’t cover — but don’t let that stop you from reading the entire article. Kevin Sack does a bang-up job of reporting on this issue, and it relates directly to the problems of having government bureaucrats making health-care choices they don’t understand. In fact, the issue provides a microcosm of what we can expect when government takes over all of our health-care decisions in ObamaCare.
First, while the ESRD program saves lives, it makes things a lot more complicated. We know, because my wife and I have lived through three kidney transplants and two periods of dialysis dependence in 14 years. Because the government covers ESRD, private insurers tend to deny coverage for anything related to ESRD once Medicare gets involved. Through all of these transplants, I had family coverage from employers who self-insure, which means they keep the premiums and the medical bills while paying the insurance company a fee for managing the program. In both cases, as soon as I left employment but kept COBRA, they immediately reversed course and refused to cover ESRD-related issues, forcing us into the Medicare system.
If anyone expects employers to maintain insurance coverage when the government implements a public option, let this serve as a warning.
On this topic, it’s painfully clear that no doctors had input on this strange decision to cut off medication funding. Kidney transplants (and almost every other type of transplant except corneal) cannot survive without immune-suppression medication. The body attacks foreign tissue without finding a therapeutic level of suppression, and cutting back or stopping the medication means destroying the life-saving transplant. This decision was made by government bean-counters and an ignorant Congress, which provided a way for insurers to cut bait and then failed to understand the problem sufficiently to structure it for long-term success. This is not a medical decision, but one by a mindless bureaucracy without any comprehension of medical necessity and therapy.
This is exactly what we mean when we decry the rationing to come in ObamaCare.... (Read It All)