When Are You Dead?

Back when dialysis was first perfected, the machines were extremely expensive and only rich people could afford to be treated. And since that's effectively a death sentence to the very large numbers of people in end stage renal disease (ESRD), there was a huge fuss. In the end, Medicare was extended to cover the cost of treatment for anyone with ESRD. No age restrictions, nothing.

When kidney transplants became feasible they were also covered. So the notion that you have to be rich or have excellent insurance to get a transplant is just plain wrong.

This is not to say that the system isn't borked, but that happens long after the transplant. Specifically, once you have a undergone a successful transplant you no longer have ESRD, so Medicare coverage stops. But your need for anti-rejection medication does not, and it's expensive. That's a separate thing, and the guidelines for it were set back when transplants rarely lasted for more than a few years. So the rules say that Medicare pays for the medication for 36 months, then coverage ends.

As a result a not-insignificant number of people with transplanted kidneys are forced to stop taking the necessary medication because they cannot afford it. Their transplants fail, and once that happens they're back in ESRD and on dialysis. And their Medicare coverage resumes. Oh, and did I mention that the medications are expensive, they're still significantly cheaper than dialysis? So this is truly a case of penny-wise, pound-foolish.

One final note. The coverage issue was addressed by the health care reform bill, but that particular provision doesn't kick in until 2014.

Source: http://rss.slashdot.org/~r/Slashdot/slashdotScience/~3/FEw2GYBJaLw/when-are-you-dead

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