US Congress favoring kidney transplants over dialysis

By Michael Fraase

Sunday, 20 December 2009 05:15PM CST

Section: ESRD

Heart attackDemonstrating yet again that they have no gift of nuance, or even common sense, Congressional Democrats are proposing to cover the cost of kidney transplant drugs at the expense of dialysis patients.

Since 1973, Medicare has covered most of the healthcare costs of those with end-stage renal disease (permanent kidney failure) regardless of age, including dialysis and transplantation. The government-run healthcare program currently ends payment for transplant anti-rejection drugs—which currently run about US$3,000 per month—after three years. Only the US Congress could institute a policy that uncaring, stupid, and wasteful. People are dying waiting for a kidney. If they get a transplant and can’t afford to pay for the anti-rejection drugs after three years, they invariably lose the organ and go back on dialysis.

According to Kevin Sack, writing for the New York Times, “Medicare spends and average of $17,000 a year on kidney transplant recipients, most of it for the anti-rejection drugs, compared with $71,000 a year on dialysis patients and $106,000 for a transplant.”

A provision of the healthcare reform bill (.pdf; 3.3MB) passed last month by the US House of Representatives extends Medicare coverage for anti-rejection drugs for transplant patients for life, starting in 2012. Unfortunately the provision is paid for by setting a flat fee for dialysis treatments and related medications—called “bundling.” Some dialysis providers argue that the new flat fee won’t cover their costs. But dialysis providers are wildly profitable—to the tune of hundreds of millions of dollars each year. They’re also wildly inefficient: Bill Peckham did the math last October (also take the time to read his comments to the Centers for Medicare and Medicaid Services on the proposed payment rule).

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