... The woman whose kidney surgery had to be redone after Medicare stopped paying for her anti-rejection drugs? Just ran in the Times:
http://www.nytimes.com/2009/09/14/health/policy/14kidney.html?ref=health
Yes, it's another potentially incendiary story that will inevitably be mentioned in one of Obama's upcoming speeches, but it's also an example of potential good will that doesn't go far enough, often out of necessity.
"The rationale for leaving out younger transplant recipients was simply that the money was not there, Congressional aides said." Not to be nihilistic, but it's useful to remember that policies put forth with the best of intentions can fall short, independent of our tireless efforts; but it's no reason to stop trying.
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Hi Marco,
Thank you for posting this article. It’s shocking that Medicare doesn’t cover immunosuppressant drugs past 36 months for younger transplant recipients “simply [because] the money was not there.” Yet, there is money to pay for dialysis and transplants, both of which are far more costly than anti-rejection drugs. How does that work? It seems like all three are covered under the same $23 billion Medicare kidney program, unless I am mistaken on this. Besides the cost-benefit that was mentioned in the article, the use of anti-rejection drugs would maintain a better quality of life than what dialysis and a brand new transplant would offer.
From this article, I am getting that the situation is that Congress is more focused on containing short-term costs (the “upfront cost of $100 million a year”) versus long-term costs (the dialysis and transplants). Are there estimates out there as to how much dialysis and kidney transplants cost Medicare per year?
Well, Nancy, that's exactly my point - it's not really all that shocking. Try as we might to cover all of our bases, there will always be something we forget to cover. It's why the idea of incrementalism is so important. It can be likened to the philosophy of continuous quality improvement in clinical care (and, increasingly, administration), where it's a recognized constant that there's always something wrong with what we're doing. The trick is finding the problem and knowing how to fix it once you find it (or at least having a framework for improvement).
It wasn't a deliberate decision to cover the more costly repeat surgery in favor of (ultimately, cheaper) continued anti-rejection drugs. That policy came from a lack of foresight that can be rectified with data and a revised policy based on that new data. Exhausting and frustrating, but the only way to improve.
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