Congress is trying to reduce US$1.2 billion in Medicare spending on dialysis patients by adding an additional year to the amount of time that private insurance (mostly, but not always, paid for by employers) is required to cover end-stage renal disease patients. Medicare has automatically covered anyone with kidney failure, regardless of age, since 1972. Since many dialysis patients are still working, Medicare requires private insurance to cover the first 30 months of dialysis treatments (employers with fewer than 100 employees are exempt). After 30 months, Medicare’s Secondary Payor system covers the costs. Congress wants to save US$1.2 billion by adding an additional year to the private insurance requirement, bringing the total private insurance coverage period to 42 months. In 1997, Congress lengthened the private insurance coverage period from 12 months to the current 30 months as part of the Balanced Budget Act.
Big business—a coalition including Boing, Caterpillar, Dow Chemical, Ford, General Electric, and United Parcel Service—is upset over these proposed changes. Mostly, according to Jeffrey Young’s account in The Hill, because “Medicare spends an average of about US$67,000 to treat a dialysis patient for a year, compared to nearly US$180,000 for employers’ health plans.” These corporations tell Young that their costs would rise by more than US$2 billion and drive up everyone’s insurance premiums.
The opposition in this case is not, as one would reasonably expect, patients, but rather the for-profit duopoly of dialysis providers, DaVita and Fresenius. Rob Forman, president of the providers’ trade association, Kidney Care Council, told Young that private insurers pay higher rates than Medicare’s because of underpayments by the government, not overpayments by the private insurers. “The Medicare Payment Advisory Commission, however, concluded this year that the program pays adequately for dialysis,” writes Young.
UPDATE: Sunday, 07 October 2007 10:15 AM CDT: To be clear, the cure for America’s health care crisis is Medicare for all: a single-payer system with universal coverage. The very system of which most American politicians are scared to death and simultaneously benefit. It’s high time for America to make a decision whether health care is a right or a privilege. Disclaimer: I’ve been a dialysis patient on private insurance for more than seven years. Only during the last year has any employer paid any part of my health insurance.
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