Cutting off transplant meds: a GovernmentCare success story

posted at 12:55 pm on September 14, 2009 by Ed Morrissey

Decades ago, Congress mandated that Medicare cover the treatment of end-stage renal disease (ESRD), including dialysis and transplants, for most patients in the US.  Currently, the system covers 250,000 people receiving very expensive dialysis treatments, which costs just under $10,000 per patient per month, which is why so many people want to increase the transplant pool, as it would both save lives and greatly decrease costs.  However, the system has a limit on support for the transplant medications needed to keep transplanted kidneys viable, which makes no sense whatsoever — and Congress has refused to address the problem.

The New York Times reports on the sadly predictable result (via Tom Maguire):

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.

Immune suppression medicine is unbelievably expensive.  Most patients have more than one medicine they take daily, and the costs can be as high as $3,000 per month for the drugs (averaging probably about half of that).  However, as the article points out, once these kidneys fail, the patients return for dialysis, which costs $9300 per month, and another transplant could cost more than $100,000 in the first year.  The first year of dialysis alone will cost Medicare more than five times what it spends on medication, and dialysis is the inevitable result of stopping the medication.

Well, not entirely inevitable.  Some people die in rejection episodes, and some people choose to die rather than face dialysis again.  One woman who worked for me at my last company came by one afternoon, a few months after she had left the company, to wish me well and say goodbye.  Her kidney had rejected (not from suspending her meds, I should note).  She couldn’t face the long hours on dialysis again, and chose to die through neglect instead.  I tried talking her out of it, but she died later that week.  It doesn’t take long for kidney failure to kill.

Not only does this government policy not prevent that, but it goes out of its way to ensure those outcomes.  It’s absurd.  Congress doesn’t need to overhaul the entire US health system to fix this disastrous intervention in ESRD.  That fix should already be in place, and separately from any other “reform” proposed by the same bureaucrats who don’t know that stopping immunosuppressant therapy will kill people.

And I’m looking at the calendar now, and realizing that three years for us will come up in March 2010.  Will my wife’s Medicare Advantage plan cover the meds?  Since that’s going away in ObamaCare, it’s hard to think of that as a comforting thought.


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Don’t count on it Ed. And good luck…

upinak on September 14, 2009 at 12:58 PM

i have a friend who gets transplant meds paid thru one of those evil insurance companies.

I hear Evan Thomas (who would be Norman Thomas’s grandson) has come out full square for the government deciding end of life questions…yes, let’s kill granny.

Cradle to Grave you know (Norman Thomas was Socialist Party of America presidential candidate)

r keller on September 14, 2009 at 1:04 PM

OT: Alexis Glick, Fox Business, is cute, but completely clueless

faraway on September 14, 2009 at 1:06 PM

This is why we will never give up the fight. My prayers for you and your family Ed.

milwife88 on September 14, 2009 at 1:07 PM

Ed, best of luck to you and the First Mate.

rbj on September 14, 2009 at 1:13 PM

Death Panels.

portlandon on September 14, 2009 at 1:16 PM

which is why so many people want to increase the transplant pool, as it would both save lives and greatly decrease costs.

Sounds like it is time to put the tonsil vultures to work on another project.

It’s going to be tough at Halloween this year, the choices for a costume are so plentiful:

Obamanazi.

Member of the Death Panel (think grim reaper with a calculator).

Angry Town Hall Participant.

Red Pill/ Blue Pill (group costume).

An Acorn Pimp.

highhopes on September 14, 2009 at 1:19 PM

So, treatment for kidney failure is more costly than pretty much anyone can afford. Good to know.
Sounds like a good case for that high deductible kind of insurance.

Count to 10 on September 14, 2009 at 1:19 PM

Ed, thanks for sharing your personal experience. Quite instructive.

And what gets me is there are thousands of perhaps similar stories out there, all of which point to the admitted need to do some tweaking with the current system.

But, if it’s bad now, one can only imagine the nightmare that’s around the corner and how your own experiences will be replicated potentially by the millions, and on all types of ailments.

Thanks again for your insight, and God bless you and the First Mate.

TXUS on September 14, 2009 at 1:19 PM

OT,

Charles Johnson now has his hate on for Robert McCain and Pajamas Media. Since Hot Air and Michelle don’t link to the Daily Kos or the Puffington Host, why do they link to the far left loon LGF that is now recycling a Max Blumenthal smear piece on McCain?

Kalapana on September 14, 2009 at 1:19 PM

Great story:

One of my lib co-workers told me about this story this morning and said this makes a bad case for more government healthcare.

My other lib co-worker has been against Obamacare ever since she heard about Ezikel Emmanuel.

There is hope people!

Joe Caps on September 14, 2009 at 1:20 PM

I wonder how many illegals are getting meds and donated organs legal American’s are not getting? With bho care, there will so many few doctors left, it probably won’t matter if the meds are available because the surgeries won’t happen.
I pray for the best for the First Mate, Ed.
L

letget on September 14, 2009 at 1:22 PM

Excellent post, Ed, and a beautiful example of the human costs of ignorant government bureaucrats setting arbitrary limits on what should and should not be paid for by government-run health insurance.

Even financially, it doesn’t make sense. To save $17,000 per year per patient on immunosuppressant drugs, Medicare then pays $9,300 per month, or $111,600 per year (6.5 times more) for dialysis. Yet Congress is worried about an additional $100 million on a $23 billion program, which works out to 0.43% of the total cost?

Exit question: Are those who cooked this up now working in the White House, claiming that a 0.1% savings in Medicare could save $4 trillion? They seem to be equally mathematically challenged…

Steve Z on September 14, 2009 at 1:28 PM

Death Panels.

portlandon on September 14, 2009 at 1:16 PM

I prefer to think of them as life panels – dispensing life to those who deserve it or are lucky!

/SARC

gwelf on September 14, 2009 at 1:30 PM

But, if it’s bad now, one can only imagine the nightmare that’s around the corner and how your own experiences will be replicated potentially by the millions, and on all types of ailments.

TXUS on September 14, 2009 at 1:19 PM

Which is why any plan passed by Congress must strip away the sweet healthplan the political class enjoys. If the need for reform is so great and the plan is so wonderful, lets have Michelle Obama have to sit in a waiting room for hours when one of the brats get sick.

highhopes on September 14, 2009 at 1:32 PM

which is why so many people want to increase the transplant pool

I can see a time in the not to distant future where in order to be eligible for National Health Care you will need to registered in a transplant pool. And very soon after that it will be mandatory for you to give up organs for the greater good. I know this sounds far fetched, but I’m sure this is already in the works somewhere.

Tommy_G on September 14, 2009 at 1:33 PM

I prefer to think of them as life panels – dispensing life to those who deserve it or are lucky.
/SARC

gwelf on September 14, 2009 at 1:30 PM

Or who of the right color. Or sexual preference. Or political party affiliation. Or who are living the right lifestyle….

TXUS on September 14, 2009 at 1:36 PM

Our Messiah has failed to cultivate and develope any credible healing skills. Until he does and learns to walk on water I’m afraid the fallin angel has met his Waterloo!

bluegrass on September 14, 2009 at 1:36 PM

which is why so many people want to increase the transplant pool

I can see a time in the not to distant future where in order to be eligible for National Health Care you will need to registered in a transplant pool. And very soon after that it will be mandatory for you to give up organs for the greater good. I know this sounds far fetched, but I’m sure this is already in the works somewhere.

Tommy_G on September 14, 2009 at 1:33 P

Absolutely dead on correct

Jeff from WI on September 14, 2009 at 1:37 PM

My prayers also to you and your family.

becki51758 on September 14, 2009 at 1:37 PM

Now all your organ are belong to us.

rbj on September 14, 2009 at 1:45 PM

Pick up a handy 6 pack of livers tonight

Jeff from WI on September 14, 2009 at 1:47 PM

Which is why any plan passed by Congress must strip away the sweet healthplan the political class enjoys.

highhopes on September 14, 2009 at 1:32 PM

Yeah, which will happen when Scarlett Johansson shows up in my house, scantily clad and with nag feature disengaged.

TXUS on September 14, 2009 at 1:47 PM

Ed,

I am a certified volunteer Medicare Counselor, and I have been following your MA experiences with your wife. If there is anything ever I can do for you, please let me know as it would be my pleasure.

You are all in my prayers. God Bless.

Maria

margategop517 on September 14, 2009 at 1:48 PM

Hmmm…as long as the LEFT sees nothing wrong with using fetal stem cells, or abortion, perhaps one daqy we’ll see the lefts dream of growing kids like a herd kept in cages, to harvest their parts. After all, they’re not really human…right?

Jeff from WI on September 14, 2009 at 1:49 PM

And I’m looking at the calendar now, and realizing that three years for us will come up in March 2010. Will my wife’s Medicare Advantage plan cover the meds? Since that’s going away in ObamaCare, it’s hard to think of that as a comforting thought.

My 23 yo Sarah is on year three of here new kidney. I’m thinking exactly the way you are Ed. What will change with the AR meds she has to take?

hawkdriver on September 14, 2009 at 1:50 PM

“her”

hawkdriver on September 14, 2009 at 1:50 PM

This will only be a drop in the bucket before all the ‘tweaks’ are in place.

I can envision diabetics being told to just modify their diets, lose some of that fat (that’s all their fault anyway according to ‘Bambi), get some exercise (thus, the reason for the fat, according to ‘Bambi) – and you’ll be fine sweety…meds, you don’t need no stinkin’ meds.

What about mental health issues? Will those specializing in that field also be subject to counceling of end of life issues?

You can take it to the bank, any highly objectionable issues that have been taken out will be slipped back in before the final signatures are dry.

To all whose loved ones have heroicly dealt with organ failures and are now facing government failures, my sincerest prayers for your safety in the years ahead.

24K lady on September 14, 2009 at 2:09 PM

AnninCA would be happier if you would not post such stories. This kind of thing does not help her get her healthCare paid for by you.

Please keep this in mind when you are Posting Stories on deaths and horrors of Government Run Medicine. (GRM)

GunRunner on September 14, 2009 at 2:19 PM

How idiotic. As a kidney donor myself (to my father) I just can’t believe that someone’s gift of life would be … disregarded in this manner.

When my father was in dialysis, he was told by the nurses that folks rarely get a kidney (out of their pool of clients – in Detroit), folks just don’t want to donate. Everyone has family members from which they can test for a match, but I guess people aren’t that willing.

As a side note: you can function perfectly well with one kidney. I’ve never been more fit in my life.

Carin on September 14, 2009 at 2:34 PM

Ed,

Continued prayers for the First Mate and your family!

juanito on September 14, 2009 at 2:41 PM

Sorry Ed, I didn’t mean to troll this thread. I didn’t read the whole thing. My condolences on the loss of your friend. With the government takeover of medicine apparently imminent, all Americans should look to starting preventive health measures. We will no longer be able to depend on health care being there if/when something goes wrong.

Kalapana on September 14, 2009 at 3:06 PM

Voter from WA State @2:30PM
Perhaps I didn’t explain well my concerns about any illness/disease being a moving target for this healthcare and/or heathcare insurance reform bill and those that will make the decisions down the road.

It isn’t going to matter a twit whether you have govn’t mandated insurance. However, you will be asked to pay for it. One by one the qualifications for treatment are going to limit and selectively disqualify many needing it. Only the very healthy between a given age group are going to find themselves covered for treatment and the meds needed to manage it.

An elderly friend is a Type II and was placed on meds – however, due to her age it’s doubtful she’d be in the approved group down the road for much help. What then? Yes, it was life-threatening because her blood pressure was off the chart. Then, this little thyroid problem surfaced..

She is doing much better these days but in the future?

24K lady on September 14, 2009 at 3:07 PM

“With Government-Run Health Care on the Horizon, U.S. Doctors Report Surge in Requests for Species-Change Operations” http://optoons.blogspot.com/2009/08/with-government-run-health-care-on.html

Mervis Winter on September 14, 2009 at 3:07 PM

It may be even more precarious for us, the lied-to military retirees and our dependents. Nursing her second kidney transplant, the wife goes in the medicare system in 5 years. Heaven forbid that will be O’s second term because I don’t imagine he’ll feel real bad about a necessity to turn the Tricare system upside down. It’s incomprehensible that “the system” would end our meds, kill our kidney and send us to the dialysis lines.

PaCadle on September 14, 2009 at 3:11 PM

I understand their was a post maintenance posting problem this weekend, I still had it today. I re-registared.

Testing

allrsn on September 14, 2009 at 3:28 PM

This is just a lone sample of the many stupid things we can expect under Obama care. We must not allow it to happen, if it does we MUST reverse it while we still can.

allrsn on September 14, 2009 at 3:30 PM

I donated a kidney to my son 19 years ago; he still has it. Just the other day, I did some ‘back of an envelope’ math and concluded that he has taken 35,000 pills so far to ward of rejection.

I am very fortunate that I have always had medical insurance through my employer(s) that has covered the vast majority of our expenses. But, even with that, I fear that The Worst President in American History cares little about Americans other than the wealthy and the healthy.

Labamigo on September 14, 2009 at 5:43 PM

I take very low dosage immunosuppressants for an auto immune disease. If my husband did not have coverage through
his retirement plan, I would run out after 3 years too. Without them it would only be a matter of time before the disease would again begin attacking otherwise healthy tissue putting me on the road to transplant. In my case transplant is notpossible as I am over the agelimit where this is feasible even under present protocols.rwq

jeanie on September 14, 2009 at 5:53 PM

As for prevention, in the case of autoimmune diseases prevention seldom/never works. If you have the gene and something triggers it(unknown at this point)you’re going to have it, period.

jeanie on September 14, 2009 at 6:08 PM

Want another example?

Elderly man with an ear infection involving his middle ear due to a perforated ear drum (tympanic membrane)…

Unfortunately, the organism is aspergillus, a particular type of fungus which can be difficult to treat…

He cannot tolerate ear drops because of the perforated ear drum -> intense pain… If not treated – there would be concern of progression through the bone and infecting the brain…

Cosequently, we are left with oral or IV (intravenous) therapy – however the standard of care medication is not generic, a second line therapy can exacerbate his congestive heart failure…

Prolonged IV therapy available can increase risk of blood clot. The cheapest therapy (amphotericin) can increase his risk of kidney toxicity – he already has poor renal function. That leaves an alternative active drug – however also not generic…

Add to this that the patient currently is in the Medicare donut… Even if not – because the other FDA approved therapies – voriconazole & caspofungin – are not generic and are considered “Tier 4″ medications – I was told that Medicare wouldn’t cover these medications anyway…

Although he also is an AARP member – his added plan through them would not cover these drugs either. (We have heard where AARP stands with the current gov’t health care proposals…)

If not for Pfizer – that big bad evil pharmaceutical company – which has agreed to provide FREE drug for treatment through the end of the year (if needed) – he would be faced with up to $3000/month (or more) to pay for therapy out of pocket (to get through the donut) – which he cannot afford at this time.

For all politicians out there… fix this type of problem first – instead of reinventing the wheel – and screwing everyone with the currently proposed plan…

Danny on September 14, 2009 at 6:42 PM

This is beyond belief. A lifetime supply of anti-rejection drugs should be part and package of any foreign tissue transplant. That is because they are required for the life of the transplant. Everyone knows this prior to the transplant. Do heart, lung or liver recipients face similar limits?

Hell, Ed, you have connections use them. Ask MM to tell Glenn Beck about this. Call your Rep/Senator and ask for a chance to address Congress. Sunlight /disinfectant.

GnuBreed on September 14, 2009 at 8:18 PM