Kidney Disease and Medicare

While most people think of Medicare as medical insurance for the elderly, it actually functions as a national health insurance program–single payer– for everyone—man,woman and child—diagnosed with end stage renal disease. Currently there are some 80,000 people awaiting kidney transplants and 400,000 people on dialysis. Transplant and dialysis are the only two ways to treat this condition. The cost to Medicare is well over $20 billion a year. Much of the money goes to pay doctors working for corporations doing dyalysis,while a considerably smaller amount is spent to transplant kidneys. Joan Lando,a California activist who is fighting greater accessibility for kidney transplant patients, wrote me the following:

You will get a shock if you call the AARP to ask about supplemental insurance if you are being denied a kidney transplant because you only have Medicare and no other insurance to cover the 20% co-pay for a transplant. Most kidney transplant centers offer transplant for people up to 70 years old, but will not even make an appointment to see you if you can’t prove that you have supplementary insurance to pay for the 20% of the transplant that Medicare refuses to pay. For no reason that makes financial sense, except perhaps to the people profiting from dialysis, Medicare pays 100% of kidney dialysis for any American in kidney failure but only 80% of a kidney transplant! Since dialysis costs Medicare $72,000 per year per patient, and maintaining a person after a kidney transplant, only costs Medicare $15,000 a year, and we currently have over half a million people in the US attached to dialysis machines, the savings to Medicare would be in the billions of dollars if these patients could get a transplant. Since virtually all people in kidney failure are totally disabled and eligible for Social Security, the actual savings to the taxpayer if these people could regain their health and careers is billions more. Also, this is Medicare money that could be used for other diseases.

The AARP could save tens of thousands of lives and save Medicare billions of dollars if they would sell supplementary insurance to people who are in kidney failure and over 55.

If you are one of the over 200,000 people over 55, (AARP’s age range), in kidney failure and need a kidney transplant to get off the dialysis machine which can only partially take the place of a functioning kidney, try calling AARP as my aunt did. Here’s how she describes the phone call, “I called AARP about supplemental medical insurance. The first thing I was told, ‘Before we discuss the plan I would like to inform you that you must be able to answer ‘No’ on the application to the End Stage Renal Disease question in order to be eligible. Are you on kidney dialysis or have kidney disease?’ My aunt does not have kidney disease,but if she had end stage renal disease it would be game over.

6 responses to “Kidney Disease and Medicare

  1. There is another tragic Medicare regulation which forces people who can’t afford medical insurance to lose their transplants. Incredibly, Medicare stops paying for the anti-rejection drugs the patient will need for as long as they have the transplant after just 3 YEARS! This is known to be one of the major reasons patients lose their transplants and are forced back into the dialysis clinic. Instead of Medicare paying the $15,000 a year for drugs to maintain a healthy transplant and allow this person to go on with their careers and lives and be free, Medicare stops paying at 3 years and once the transplant is rejected, Medicare is obligated to pay the full cost of dialysis, $72,000 a year and all the other medical bills for this critically ill patient. Most dialysis patients cost Medicare about $150,000 a year for dialysis, hospitalizations and re-surgeries for dialysis access.

    There is a bill currently in the Senate S 565, and in the House HR 1458 that would extend the time Medicare pays for the anti-rejection drugs for as long as the transplanted kidney is functioning. It is beyond comprehension that this isn’t already the law.

    Calling or e-mailing your Senators and Representatives and asking them to co-sponsor this bill will lead to hearings on this issue for the first time. The consequences of the current regulations is that not only do many people lose their transplants because they can’t afford their drugs, but it is estimated that at least 100,000 of the half of million people on dialysis who have living donor offers, are refused evaluation for a transplant if they don’t have private insurance and can prove to the transplant center that they can pay for their drugs after Medicare cuts out at 3 years.

    If these people could instead be transplanted, the savings to Medicare would be over $10 billion a year.

    This one simple bill in fact offers the biggest savings to our Medicare funds of any other single bill introduced in Congress this year. AND, NO ONE HAS HEARD OF IT! Go to a dialysis corporation business blog and find out that they are now calling themselves “recession proof”. Losing so few patients to transplant, dialysis corporations are showing vigorous growth. Of the half a million people in kidney failure, only 16,000 (3%) got a transplant last year and that was down over 200 from the year before. Click on CONFLICT OF INTEREST at getakidneytransplant.org to get an understanding of why similar bills have never even gotten hearings in Congress. Perhaps it is time to explain to the tens of thousands of children in kidney failure whose parents don’t have private insurance the effectiveness of corporations and doctors quietly lobbying Congress for the status quo that denies them Medicare coverage for transplant, but makes them golden geese on the dialysis machines. These kids can’t grow properly attached to the machines or go to school.

    Obama and Congress can fulfill their campaign promises to improve health care for hundreds of thousands of Americans and save Medicare billions of dollars, by giving transplant the same coverage Medicare gives to the dialysis. As Dr. Tom Starzl, the father of kidney transplant, has said, the flow of gold from Medicare to dialysis clinics has provided a disincentive for transplant. For three hours, three days a week in my daughter’s old dialysis clinic a tiny little man used to cry out continuously, “Help me, help me, somebody help me!” All that is necessary for evil to prevail is for good men to do nothing.

  2. I’m twenty-six years old, a university student student Business and a kidney transplant recipient. I met Joan Lando (previous post) 2 years ago and she helped educate me and my family on kidney transplants, Medicare and the effects of dialysis…not to mention the monetary costs to Medicare and private insurance companies to keep people on dialysis.

    I went through nearly 3 years on dialysis and was told by a very prominent transplant center that my donor (my dad) and I did not match blood types but they were starting a new program to make it successful (although I later found out because of insurance issues, I was going to be the first patient to undergo their protocol…I refused because of the inexperience). I told them about Dr. Stanley Jordan (whom I learned about through Joan) and that I was going to be transferring to Cedars-Sinai in Los Angeles. My insurance, and doctor balked at the thought for an entire year before I was finally transferred.

    At the time prior to my transfer, my insurance did not have a contract with Cedars, but my fight to get there helped propel my insurance Cedars to come into an agreement so that future patients would not have to fight like my family did. I successfully had my kidney transplant on March 24, 2009 and both my dad and I are doing very well. In fact, the incompatible program the prior transplant center was trying to get me to do was Medicare approved at Cedars under Dr. Jordan’s direction. He is a pioneer in the field of ABO incompatible kidney transplants and because of it, I’m alive and well today. I am forever grateful to Cedars, Dr. Jordan and Joan for everything they did to help me. I HIGHLY recommend Cedars-Sinai for ANYONE who needs a kidney transplant. It is the PATIENT’S RIGHT to go wherever they feel most comfortable!

    For more information on the ABO Incompatible Kidney Transplant program involving the Cedars-Sinai protocol, please visit my website:
    http://ABOIncompatibleTransplants.com

  3. There is something else that could help save medicare money, if more people awaiting transplant knew of the Cedars-Sinai IVIG (intravenous immunoglobulin) protocol medicare could save billions of dollars annually. I had my transplant a little over 3 years ago, but only after nearly 4 years of on again off again dialysis and feeling horrible day after day due to non-functioning kidneys. My doctors, in SF, never told me about Cedars protocol for high dose IVIG. I found out about IVIG after some research and a nurse’s clues to something other than dialysis being a possibility. Doctors, whose hospitals don’t offer IVIG, don’t discuss it because they do not want to lose patients. Losing patients means losing 18,000-20,000 a month per patient. I have yet to find a “dialysis nephrologist” willing to give up money for the good of a patient. Many transplant nephrologists, it turns out, are the same way. Unfortunately for our health care system, much of which is paid for by medicare (since end stage renal failure is automatically considered a disability covered by medicare), the doctors desire to earn income from dialysis is costing this country billions a year. As Ms. Lando states 10 billion a year could be saved if all the people on the transplant list were transplanted. Imagine what medical good the country could do if medicare had an extra 10 billion dollars!!! I hope that with your articles and the help of others people learn about high dose IVIG and are able to get their lives back. My life would be nowhere near the same if I were still on dialysis. I would not be a teacher, I would not be at the gym training to hike Yosemite, I would be tied to a machine 3 days a week for 4 hours at a time, my life draining out of me. Please help to spread the word about Cedars-Sinai high dose IVIG protocol. Help people help themselves, allow medicare to save billions of dollars annually and lastly keep dialysis nephrologists from profiting from other people’s torture. Thank you for your article, I look forward to reading more from you about kidney disease and medicare.

  4. My name is Chasidy and i need help my kidney transplant is going on 3 years this mth. Medicare says i will lose my card i don’t know what to do if anyone knows information about getting help to pay for my medications please let me know. Thanks my e-mail address is delana026@yahoo.com Thanks again………

  5. Great blog, reading it through RSS feed as well

  6. Casidy – I suggest that you print out this article (easier than telling the story of this Medicare debacle – keeping people deliberately chained to a machine) to all local newspapers (go in person find a good reporter). Contact news – radio stations / send the article – to newscaster/producer marked URGENT – Medicare Demands That I Reject Transplant – Money Wants Me a Slave to a Machine. Also the Washington Post is a great paper for investigative reporting/ Send the article and your story to them.

    Most people (I didn’t) never realized until reading this article that Medicare (diabolical) refuses to pay for needed medication but will pay tens of thousands more to keep you attached.

    Go everywhere you can ( make dozens of copy of this article): Feminist groups/ ACLU -write letters to Editor – Send your story to me and I will get it out to editors that I know – places I write for.

    Tell me your age – when you contacted kidney disease – what hardships this refusal for medications thus lose of transplant will cause you – etc. Basically your life story. Send address, contact info. I don’t know what else to do – we can TRY. jdthmoriarty@yahoo.com

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