Rationing Medicare

Most people do not understand how Medicare rations treatment. Medicare will not cover transplants in facilities which are not approved. Approval is based on the success rate in the previous two years. Here is an example using heart transplants. Initially, the facility must demonstrate actuarial survival rates of 73 percent for one year and 65 percent for two years for patients who have had heart transplants since January 1, 1982 at that facility. If the facility wants to keep its approval they must be careful as to which patients they accept. Knowing this they will decline someone who appears to be a bad risk. An extreme example would be a 90 year old man with a bad liver. The point is the facility has a committee which will make this determination. Previous studies in heart transplantation have demonstrated higher mortality, decreased graft survival, and higher rates of rejection for recipients receiving heart transplants with Medicare or Medicaid health insurance coverage compared with those with private health insurance. In addition hospitals absorb about $50 billion per year losses in Medicare patients. They offset much of this with higher cost for private patients and this source will be lost with Medicare for all plans.