Date: July 1st, 2002
Medicare, simply stated, is the government's contract that it will provide healthcare insurance coverage for older Americans. But as with all contracts, it pays to read the fine print. And that's when the jarring gaps begin to emerge. In Medicare's desperate attempt to cope with the initial high costs for all the newest medical and technological advances, many are suffering the affects of prevention and treatment denial.
Consider mental health care, a significant concern among older Americans. Medicare requires patients to pay fully half the cost of outpatient psychotherapy treatment. By contrast, individuals with cancer or diabetes pay only the standard 20 percent Medicare co-payment for their treatment. So why should these same individuals be forced to pay a 50 percent co-payment to get treatment for depression? Left untreated, depression could be every bit as lethal as cancer or diabetes.
The American Psychiatric Association argues that Congress would be justifiably outraged if Medicare forced cancer patients to pay for half their lifesaving treatments. So why is it reasonable to tell the 75-year-old that she must pay half the cost of treatment for major depression?
Rep. Marge Roukema (R-NJ) has introduced legislation (H.R. 599) requiring that psychiatric patients pay no more for their care than those being treated for purely physical ailments. A companion Senate bill (S.841) has been introduced by Sens. Olympia Snowe (R - Maine) and John Kerry (D-Mass.)
Even when Medicare officials seem about to do the right thing, they are capable of some remarkable reversals. Their "about-face" on treatment of age-related macular degeneration, or AMD, is a classic case. AMD is a vision disorder that is the leading cause of blindness among seniors. An estimated 1.7 million of those over 65 have lost some degree of their vision from AMD.
In one form of the disease, occult, or hidden, blood vessels in the eye bleed into the central region of the retina, known as the macula. The result is a permanent loss of central vision within weeks or even days.
But last October, a glimmer of hope appeared for AMD sufferers. The Department of Health and Human Services announced that it intended to expand Medicare coverage to include a treatment known as "Ocular Photodynamic Therapy (OPT) using the drug verteporfin. HHS Secretary Tommy Thompson said at the time, "By expanding access to this important new treatment, we are improving the quality of life for many Medicare beneficiaries."
It's important to note that this procedure is not a cure; it is designed to simply slow the deterioration. And, because it is temporary, the procedure may need to be repeated. Nevertheless, it remains one of the only effective treatments available for this form of AMD. Medicare's decision to cover OPT was widely hailed by AMD sufferers and eyecare specialists.
Then came Medicare's stunning reversal last March. Officials explained that their earlier decision may have been premature, that it was based on a single clinical trial involving a small numbers of patients, that the treatment was still experimental, and that "we may have materially misinterpreted data crucial to determining the effectiveness of the treatment." Translation: We goofed.
The policy reversal was necessary, government said, because the therapeutic benefits, if any, were limited at best, and that a few patients even experienced sudden and severe vision loss. What they failed to explain, however, was why none of these concerns were addressed in the 18 months of study and evaluation that preceded the October 2001 announcement. Bottom line? Cost.
Medicare is in a precarious position. The agency is at the crossroads of a vastly expanding aging population and an explosion of new medically advanced technologies designed to answer the health challenges of human aging. However, what to cover and what not to cover should not be assessed on short-term cost savings. Denying access for older Americans to effective new medical treatment accelerates the loss of independence and therefore costs our country far more in the end. We need to find better ways to assess the value of new health techniques and technologies. And we need to find that better way well before the giant Baby Boom population starts moving onto the Medicare rolls nine years from now. Saying "no" to the very innovations that can secure health and extended independence simply to save money in the short term is short-sighted.
What you can do:
- Contact your senators and representative and urge them to support the Medicare Mental Illness Non-Discrimination Act.
- Contact the Centers for Medicare and Medicaid Services (CMS) at their website www.cms.hhs.gov/feedback/ and urge them to reconsider their decision not to cover treatments for occult macular degeneration.
- Contact your senators and representative and urge them to support the Access to Cancer Therapies Act.