(CHICAGO, October 5, 2007) The Centers for Medicare and Medicaid Services (CMS), which pays the bills and writes the regulations for Medicare and Medicaid, has proposed new guidelines under which it will not in some circumstances pay for use of drugs called erythropoiesis-stimulating agents (ESAs) that improve anemia (thin blood).
The following statement was released today by Dr. John Dale Dunn, M.D., J.D., who serves on the Emergency Medicine Faculty at Carl R. Darnall Army Medical Center, Fort Hood, Texas. Dunn, a policy advisor to The Heartland Institute, can be reached at firstname.lastname@example.org or by phone at 325/784-6697.
"Current medical guidelines call for bringing anemic patients up to 11-12 grams of hemoglobin per deciliter (g/dL), slightly less than normal hemoglobin levels. These guidelines provide great benefit at minimal risk and are medically sound. The guidelines are rational and should be left in place. CMS should not change its guidelines to pay for anemia drugs only when they are used to bring patients up to 10 g/dL.
"Hemoglobin of 10 g/dL is still anemic, but patients with cancer or kidney disease often have hemoglobin down to as low as 5 or 6, causing them much difficulty. That's why these very anemic patients look and act so pale, grey, weak, and tired.
"Lately kidney and cancer specialists have found that pushing the hemoglobin to 11 or 12 (normal is 13 or 14) improves the quality of life and well-being of these patients, so now conventional medical practice and even the Food and Drug Administration recommend prescribing ESAs to treat hemoglobin levels between 11 and 12.
"CMS's plan to cut off funding for ESAs for some patients highlights how impersonal government agency planning can be cruel to the most vulnerable of our citizens. Government planners, interested in saving some money on an expensive class of drugs, would unilaterally over-rule medical science and substitute their own lower hemoglobin level recommendation.
"In a centrally planned health care system, this kind of decision-making is commonplace. In government health systems, the sick (who are few) may be ignored while services for the healthy (who are numerous) get funded. In Britain, for example, baby-sitting and social services are funded as health care services while access to surgery and cancer treatment are rationed. The losers in a British-type system are the people with limited political clout and serious illnesses.
"It is alarming that government agencies would deny people with terrible illnesses a better life just to reduce government costs. To those who said it couldn't happen here, the CMS plan to cut funding for ESAs should be a wake-up call."
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