A Medicare Cap That Ends Up Costing System More Money

If you ever needed an reminder of how the American health-care system spends a lot of money on patients for poorer outcomes than other countries, you need read no further than an example in the New York Times this morning that describes how a limit on Medicare coverage can boomerang.

The scenario: Medicare’s three-year limit on payment for anti-organ-rejection drugs led to a woman needing a second kidney transplant, because she couldn’t afford to the medicine that would have allowed her to keep her first transplanted kidney in healthy, working condition.

The cost of anti-rejection drugs for the patient? $1,000 to $3,000 a month. Cost of the second transplant? $125,000. The average Medicare expenditure per kidney transplant patient care is $17,000 yearly, while it’s $71,000 a year for dialysis patients and $106,000 for a transplant, according to the Times.

The policy is one that could change with an overhaul of the health-care system. The House health reform bill includes a proposal to reverse it — these drugs would thus be covered indefinitely — but whether the Senate will agree isn’t clear, notes the NYT. The upfront costs of making the change are large, with the Congressional Budget Office estimating that unlimited drug coverage would add an additional $100 million to the Medicare budget.

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