Not the time for reckless funding change for dialysis
As everyone knows, the U.S. Congress is in a budget-cutting mood. The creators and overseers of our inflated federal budget have seen the error of their ways, and now they are getting serious about budget reduction. They are determined to cut the fat where it is least needed: kidney dialysis.
Wait a minute, some people (myself included) might say. Kidney dialysis — the cleaning of blood for people whose kidneys are no longer up to the job — is a life-saver. With the kidney-killing disease of diabetes on the rise nationally, and with long waiting lists for organ transplants and no “mechanical kidney” looming on the medical horizon, it is perhaps more necessary than ever. Dialysis has been a federally-funded Medicare program for many years, but now some in Congress want to whittle down its cost. Cost-control is of course important, but as we in Vermont are discovering, changing the health care system must make the patients’ needs a first priority. For them — and sooner or later you and I will be one of “them” — such changes are potentially a matter of life and death. For our sakes, Congress cannot afford to act now and fix unwanted problems later.
In brief, here is what’s happening in the corridors and committee rooms of Congress, as reported in the Jan. 19 New York Times. The battleground, for the moment, is the cost of dialysis-related medications called, “End Stage Renal Disease” (ESRD) drugs, which help the sickliest patients. Two years ago, the U.S. General Accounting Office warned Congress that they should act carefully in setting compensation levels. As an aide to a U.S. senator told the Times, “sometimes when you try to do too much, and too quickly, you screw up.” Nevertheless some in Congress are trying to overturn a well-needed two-year period of merging the funding of these medications into the entire “bundle” of dialysis funding. Unfortunately, if Congress were to not follow the recommendations of the GAO report and bundle a special group of life-saving medicines, patient access to them would be jeopardized. Federal lawmakers did the right thing by including a provision in the fiscal cliff bill temporarily extending the current way that Medicare Part D covers certain medications while other major changes are being made to the way Medicare pays for dialysis care.
If this all sounds like inside baseball – well, it is. Even in the Vermont Statehouse, it was often hard for me, as a member of the House of Representatives, to determine, much less describe, all of the powerful moves, countermoves, and forces behind “health care reform.” Over the years I found that the best way to judge the rightness or wrongness of an issue was to judge, as best as I could, who in the “real world” would be helped and who would be hurt.
In this case, it is the estimated 388 Vermont dialysis patients themselves who are most at risk. Dialysis is a “land of limbo.” For some it is a way of staying alive while doing one’s time on the transplant list. For others, it is the only way to avoid death by kidney failure. Vermont, to its credit, has developed a top-line system of dialysis centers, where skilled specialist technicians and doctors develop ongoing relationships with their patients, most of whom must visit for several hours about three times a week. While I support intelligent healthcare cost-saving, charging ahead with wholesale changes in dialysis treatment is hardly the place to start. Congress – including our lone Congressman, Peter Welch – must take a deep breath and use the prescribed waiting period and move carefully, thus ensuring the high quality of this vital program.
Steve Adams served Hartland and West Windsor in the Vermont House of Representatives from 2001-2010.