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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