Editorial: Wasting taxpayer dollars, ruining lives

The situation is illogical, shocking and infuriating — but somehow, it's not totally surprising in the world of health care.

As The Star reports in a two-day series this weekend, the U.S. government has a strict three-year limit on how long it will provide medicine that people need for the rest of their lives to keep a transplanted kidney healthy.

The anti-rejection drugs cost $17,000 a year. Once the government drug benefit runs out, a person typically has no health insurance, cannot afford to buy the drugs and stops taking them. Then the kidney fails.

At that point, the government willingly provides a lifetime of dialysis treatments at a cost of $71,000 a year, or four times the cost of the anti-rejection medicine. But, wait — it gets even worse.

After Medicare covers the $100,000 average cost for a kidney transplant and the organ fails because the drug benefit ran out, then Medicare will cover a second kidney transplant costing another $100,000 even though the replacement organ also is doomed to fail when the drug benefit expires 36 months later.

That is an illogical, absurdly wasteful situation, and unfortunately it tends to reinforce every cliche about government incompetence and health care nightmares.

A federal lawmaker offers a better approach. U.S. Sen. Richard Durbin, an Illinois Democrat, proposes a lifetime benefit for kidney transplant medication. His plan involves taking slightly more than 1 percent of the government's $8.6 billion annual outpatient dialysis budget and shifting those dollars to pay for kidney transplant medication coverage.

However, his legislation has been defeated twice. As it turns out, dialysis is a multibillion-dollar industry and powerful forces are working to protect the companies' revenue stream, including DaVita and Fresenius, the nation's largest dialysis providers, and dialysis drug makers such as Thousand Oaks-based Amgen, the largest private employer in Ventura County.

Despite that opposition, Congress should pass the Durbin legislation, which provides a clear solution to the current indefensible situation.

As writers John M. Gonzales and Tom Kisken report in The Star's series, the numbers back up Sen. Durbin:

- The success rate is approaching 90 percent on kidney transplants.

- According to one estimate, more than 140,000 Americans are kidney transplant patients whose Medicare benefits have expired for the post-transplant anti-rejection drugs they needed.

- A 2009 survey found that two-thirds of kidney transplant programs had some patients who either lost kidneys or died because they couldn't afford the medicine.

We believe those numbers are utterly unacceptable to most Americans, and the current circumstances no longer should be tolerated by officials at the national level. Popular support for such a shift seems assured when one considers that taxpayers actually would save money in the long run if U.S. policy makers changed their direction and started doing the right thing for kidney transplant patients.

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