This site has raised concerns over coverage limitations and rationing in health care before, especially in light of ongoing debates in Washington DC. The article below points to the totally illogical practice of Medicare, which covers end stage renal disease and transplantation, whereby life saving immunosuppressive drugs are only covered for three years post transplant – the assumption being that these patients now “no longer” have renal failure. Only government bureaucrats could be so lame and insensitive in their interpretation of coverage decisions. Oh, we know, Medicare can’t pay for everything, that is a fact, but to allow patients the “gift of life” via a transplant, then three years later pull the rug out due to the “rules of the program” is beyond cruel and unjust. We need officials who will deal with health realities more honestly. If Medicare no longer wishes to have end stage renal disease carved out as an exception which allows those under 65 to qualify for Medicare, then change that rule on the front end, not on the back end, and deal with the political heat, or get out of the kitchen . . . jomaxx
Margaret Oliver, a 47-year-old hairdresser in Venice, Calif., received a lifesaving kidney transplant in 2002. The government covered the costs under a special Medicare program for the hundreds of thousands of Americans with kidney failure who need either dialysis or a transplant. Three years later, Medicare stopped paying for the expensive immunosuppressive drugs that Ms. Oliver needed to minimize the risk that her body would reject the organ. Because her kidney was functioning successfully at that point, she was no longer considered to be suffering from end-stage disease and so no longer qualified for the special coverage
Read more @ http://www.nytimes.com/2009/03/13/health/13kidney.html?_r=1
http://www2.niddk.nih.gov/
http://www.kidney.org/
“If Medicare no longer wishes to have end stage renal disease carved out as an exception which allows those under 65 to qualify for Medicare, then change that rule on the front end, not on the back end, and deal with the political heat, or get out of the kitchen . . .”
Fascinating suggestion.
Kinda like after 100 days in a skilled nursing facility residents are considered “custodial” and Medicare stops paying.
After the medical issues are addressed, the conversation is about money.
The monetary safety net for Medicare is not more Medicare. It’s Medicaid.
Getting there is straightforward. It’s called “spending down.”
Right you are – it’s not the money, it’s the money! So, if Medicaid is your solution, then I assume you are convinced that in the scenario reported on Medicaid will pick up all the drug costs. Not likely. I think many folks find these kinds of problems to be of an academic or intellectual nature, however, if you are the patient or provider struggling with this, it is far from that. Your comparison to a nursing home situation is interesting and would be relevant if Medicaid picked up the tab on all costs when Medicare funding ceased. However, that is far from the case. There are no easy solutions, we all know that, but we need to keep trying to find them . . . jomaxx