Medicare’s Troubling Limitations

Thanks to Glenn Reynolds of Instapundit for a link over the weekend to a post here by Joe Roche (a post which also was published in short form as an op-ed in the Sunday Washington Times).

Speaking of Instapundit, Glenn’s regular readers will recall his recent posts about his wife Helen’s hospitalization for implantation of an implantable pacemaker/cardioverter.

Said Glenn of the device: “The good news is that those things are available…”

He’s right. But for Medicare patients, that good news is nothing to take for granted. Many of them simply haven’t been able to get the device.

As our Ed Haislmaier reports for us, Medicare patients haven’t had the same access to these devices as Americans with private health insurance have had. Says Ed:

[In]1985, the FDA approved the first implantable defibrillator and by 1989 the first cardioverter-defibrillator that could deliver a multi-stage shock therapy to correct heart rhythms. Since then, device companies have continued to innovate, simultaneously making ICDs more sophisticated and less costly.But the story involving Medicare isn’t so positive. Medicare first agreed to pay for ICDs for a limited number of patients in 1986. But it was not until 1991, and then again in 1999, that Medicare further expanded its definition of ‘medical necessity’ to cover ICDs for more Medicare beneficiaries.

In the spring of 2002, armed with new clinical trial data from the New England Journal of Medicine, ICD makers asked Medicare to further expand coverage. A year later, Medicare’s Coverage Advisory Committee unanimously endorsed the expansion. By that time, private insurers were already paying for ICDs for patients with the same characteristics and the American Heart Association and the American College of Cardiology had already revised their treatment guidelines.

But not until June of 2003 did Medicare agree to a further coverage expansion, and then only to one-third of the recommended patient population. Only now is Medicare finally agreeing to the full ICD coverage criteria the private sector adopted two and a half years ago.

In announcing plans to expand coverage for IDCs, Medicare touted that it expects 25,000 more patients will receive IDCs in 2005, “potentially saving up to 2,500 lives.” Thus, we may infer that Medicare’s foot-dragging, bureaucratic coverage process probably resulted in the avoidable deaths of between 5,000 and 10,000 Medicare patients over the past two and a half years.

A big reason for Medicare’s foot-dragging on IDCs is cost…

The hard truth is that, like national health systems abroad, Medicare saves money by limiting the availability of life-saving care…

Read Ed’s entire piece here.

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