By Bill Peckham
RenalWeb links to a front page New York Times article When Ailments Pile Up, Asking Patients to Rethink Free Dialysis by Gina Kolata. This is the article's leed:
Of all the terrible chronic diseases, only one — end-stage kidney disease — gets special treatment by the federal government. A law passed by Congress 39 years ago provides nearly free care to almost all patients whose kidneys have failed, regardless of their age or ability to pay.
Access to Medicare does not equate to "nearly free care" and not everyone has earned Medicare access.
Right now Medicare leaves about $50 per treatment unpaid and the responsibility of the beneficiary (Medicare routinely pays 80% of approved charges). Given 156 treatments a year this amounts to about $7,800/year unpaid, just for the dialysis ... in addition the beneficiary incurs 20% of the cost of doctors, nondialysis medications and any other medical care required outside the dialysis unit.
Also, not all individuals with ESRD are eligible for Medicare, about 10 to 15% will never have access because in addition to a diagnosis of ESRD, one of the following criteria must be met (PDF link):
- The individual must meet the required work credits under Social Security, Railroad Retirement or as a government employee
- The individual is receiving Social Security or Railroad Retirement benefits
- The individual is the spouse or dependent child of a person who has met the required work credits or is receiving Social Security or Railroad Retirement benefits.
Currently the required work credits under Social Security is 40 quarters - 10 years of paying into the program - there is a detailed explanation here.
But the article's error laden leed is not even its worse offense. It continues:
But the law has had unintended consequences, kidney experts say. It was meant to keep young and middle-aged people alive and productive. Instead, many of the patients who take advantage of the law are old and have other medical problems, often suffering through dialysis as a replacement for their failed kidneys but not living long because the other chronic diseases kill them.
No no no. Dialyzors who are "old and have other medical problems" have access to Medicare due to age or disability, "patients who take advantage of the law" are few: only about 25,000 people have access to Medicare as a consequence of Section 299I of the Social Security Amendments of 1972.
The article does shine a light on an important discussion about end of life care and informed consent. That's an important subject, however, it is only tangentially related to the ESRD Entitlement. The point of the article is that caring for the elderly is expensive and aggressive treatment may not always be in the interest of the ill. That is a serious discussion our electorate should have but has not been able to have; this article makes that discussion even more difficult.