By Roberta Wager, RN, MSN

Although it may come as a shock to many Americans, when it comes to quality of care for people suffering from kidney failure, the United States has fallen behind the rest of the industrialized world. The U.S. ranks last among seven industrialized nations in the care of kidney patients.

Each year, 23% of patients in the U.S. with end-stage renal disease (ESRD) die. That is significantly higher than the mortality rate in Europe (16%) and the much lower mortality rate in Japan (9%). This translates into a tragic reality: U.S. end-stage kidney patients have a life expectancy of only 5 years.

Congress, unfortunately, is now considering a proposal that will only make things worse. Medicare currently pays for dialysis and other services for ESRD patients. Congress is looking at delaying Medicare payment for some patients until 42 months after they are diagnosed with end-stage renal disease.

Here’s the problem: because end-stage patients have a life expectancy of 60 months, delaying Medicare for 42 months would mean that many patients would not even live to see to see the benefits of Medicare as their primary payer.

Congress created the Medicare ESRD Program in 1972 specifically for the special needs of end-stage patients as they struggle with this debilitating disease and its intensive treatment and management. The federal government provides comprehensive coverage and cost-effective methods of treatment. Medicare has effectively developed quality assurance measurements and structured a cost-conscious reimbursement system – balancing the needs of kidney patients with costs.

The American Association of Kidney Patients – the only national non-profit organization founded by kidney patients, for kidney patients – was there at the beginning of the program. And the organization has been dedicated to serving the needs, interests, and welfare of all kidney patients and their families ever since.

We know from 35 years of medical history that patients are better off receiving the comprehensive spectrum of services required under the Medicare ESRD Program. Private insurance, on the other hand, is not required to cover as many services, and is always subject to future uncertainty in negotiations between business and labor and between employers and insurance companies. That’s why a policy to delay Medicare coverage would be bad for patients.

It would also be bad for everyone else in the country because delaying Medicare coverage would actually increase the nation’s health care costs.

Payers other than Medicare have to pay 2 to 3 times as much for the exact same dialysis services as Medicare does. Private insurers paying more money for dialysis for more patients for a longer period of time means higher costs for everyone. The costs will be passed on in higher premiums and higher co-pays for you and me.

As a result, the nation as a whole will pay billions of dollars more for the same services with no increase in benefits.

At this contentious time within health care, policymakers, employers, labor, and patient groups are actively seeking ways to ensure quality, expand access, cover the uninsured, and reduce the rising costs of health care. There are ways to reduce Medicare costs while still protecting kidney patients, such as common sense bundling for Medicare reimbursement of all ESRD services.

But, frankly, putting Medicare coverage off for 42 months for patients expected to live 60 months is a pretty cynical policy. It would be a big step in the wrong direction.


Roberta Wager is a nephrology nurse who has received two separate kidney transplants. She is President of the American Association of Kidney Patients. This article was written in response to the proposed extension of the Medicare Secondary Payer provision..

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