美国国家公共电台 NPR Medicare Pays For A Kidney Transplant, But Not The Drugs To Keep It Viable

 

RACHEL MARTIN, HOST: 

We're going to talk about a very specific health problem now - kidney failure. The federal government will pay for expensive transplants for patients whose kidneys aren't working anymore. But after three years, the government will often stop paying for the drugs needed to keep that transplanted kidney alive. Thousands of people get caught up by this particular feature in the federal kidney program. NPR's Richard Harris tells the story of one woman facing that deadline.

RICHARD HARRIS, BYLINE¹: Hundreds of thousands of Americans get dialysis, typically four hours a day, three days a week to keep them alive once their kidneys fail. Medicare pays for this, even for people under the age of 65. Constance Creasey found herself in need of that service about a dozen years ago after her kidneys failed.

CONSTANCE CREASEY: The first three years of dialysis was hard. I walked around with this dark cloud. I didn't want to live, I really didn't.

HARRIS: Being dependent on these blood cleansing² machines was physically³ and emotionally draining, but she stuck it out for 11 years as she waited for a kidney transplant also funded by Medicare.

CREASEY: Finally a year and a half ago, transplant came. I was a little apprehensive⁴ but I said OK. And I call her Sleeping Beauty, that's my kidney's name.

HARRIS: Creasey, a 60-year-old resident of Washington, D.C., no longer needs to spend her days at a dialysis center. She has enough energy for a part time job at a home furnishing store and time to enjoy life's simple pleasures.

CREASEY: I was able to do my favorite thing is go to the pool. And I was just loving it because it's like I had no restrictions⁵ now.

HARRIS: But there is still a dark cloud on Creasey's horizon. Medicare currently pays for a large share of the expensive drug she needs to take twice a day to prevent her body from rejecting the transplanted kidney. But under federal rules, that coverage⁶ will disappear three years after the date of her transplant.

CREASEY: I have a year and a half to prepare or say save. How am I going to do this?

HARRIS: She's already paying copays, premiums⁷ and past medical bills. And she says she sleeps on the floor because she considers buying a bed a luxury she can't afford. She has no idea what kind of insurance she'll be able to get after her Medicare coverage runs out and she was shocked to discover how big the bills could be. One day, she went into the pharmacy⁸ to pick up her drugs and the Medicare payment hadn't been applied⁹.

CREASEY: They were like it's 600 copay. And I'm like, are you kidding me, 600? And I'm just like, what am I going to do? I can't pay that.

HARRIS: A social worker at MedStar Georgetown University Hospital, where Creasey got her transplant, sorted that out but it's not a permanent solution. Dr. Matthew Cooper, who runs the Kidney Transplant Program at the hospital, says this three-year cutoff for Medicare payments is a common problem, especially since many people with serious kidney disease have low incomes in the first place.

MATTHEW COOPER: That's probably about 30 percent of people that find themselves in a troublesome spot at this 36-month mark.

HARRIS: Cooper says some people end up trying to stretch out their drug supplies by not taking them as often as they need to.

COOPER: We see that a lot, you know, and it's a shame because you realize that people have real problems, real life problems where they're deciding, do I get my medications this month or do I pay my electric bill?

HARRIS: But this isn't like skipping a pain pill and bearing the consequences. People lose their transplanted organs if they don't take their medicine religiously. Assuming that doesn't kill them, they end up back on dialysis that costs $90,000 a year and is paid for by Medicare indefinitely. That's a lot more than the $15,000 it would cost to provide the drugs.

COOPER: The Medicare dollars in savings¹⁰ alone in maintaining this drug coverage is better than putting people on dialysis. To me, this is a no-brainer. I just cannot understand why we haven't got to the point where we say Medicare covers for life for immunosuppressive drugs because people will benefit and money will be saved.

HARRIS: Cooper has been trying to make that point on Capitol Hill, but legislation to fix this has always stalled out. Kevin Longino, head of the National Kidney Foundation, has been lobbying, too. He says in a Skype call, it's not just affecting the people who have transplants, but those who are on the long list waiting their turn for an organ to become available.

KEVIN LONGINO: The tragedy is you've got so many people on the wait list already and to have someone necessarily have rejection¹¹ because they can't afford the drugs and have to go back into the system. It's just a difficult thing to explain why that - why we're allowing that to happen.

HARRIS: Lawmakers are concerned about the costs. Severe kidney disease already costs Medicare a staggering $30 billion a year. And the Congressional Budget Office never figured out whether the bill would save money overall or add to the costs of the program. But for Constance Creasey, this is not an abstract conversation.

CREASEY: Those pills are my life right now. Yeah. I'm trying not to worry, but it's hard.

HARRIS: Congressman¹² Michael Burgess of Texas and Ron Kind of Wisconsin plan to reintroduce their bipartisan bill to fix this problem again next year. Richard Harris, NPR News.

1 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

2 cleansing   

n. 净化(垃圾) adj. 清洁用的 动词cleanse的现在分词

参考例句：

• medicated cleansing pads for sensitive skin 敏感皮肤药物清洗棉
• Soap is not the only cleansing agent. 肥皂并不是唯一的清洁剂。

3 physically   

adj.物质上，体格上，身体上，按自然规律

参考例句：

• He was out of sorts physically,as well as disordered mentally.他浑身不舒服，心绪也很乱。
• Every time I think about it I feel physically sick.一想起那件事我就感到极恶心。

4 apprehensive   

adj.担心的，恐惧的，善于领会的

参考例句：

• She was deeply apprehensive about her future.她对未来感到非常担心。
• He was rather apprehensive of failure.他相当害怕失败。

5 restrictions   

约束( restriction的名词复数 )； 管制； 制约因素； 带限制性的条件（或规则）

参考例句：

• I found the restrictions irksome. 我对那些限制感到很烦。
• a snaggle of restrictions 杂乱无章的种种限制

6 coverage   

n.报导，保险范围，保险额，范围，覆盖

参考例句：

• There's little coverage of foreign news in the newspaper.报纸上几乎没有国外新闻报道。
• This is an insurance policy with extensive coverage.这是一项承保范围广泛的保险。

7 premiums   

n.费用( premium的名词复数 )；保险费；额外费用；（商品定价、贷款利息等以外的）加价

参考例句：

• He paid premiums on his life insurance last year. 他去年付了人寿保险费。 来自《现代英汉综合大词典》
• Moves are afoot to increase car insurance premiums. 现正在酝酿提高汽车的保险费。 来自《简明英汉词典》

8 pharmacy   

n.药房，药剂学，制药业，配药业，一批备用药品

参考例句：

• She works at the pharmacy.她在药房工作。
• Modern pharmacy has solved the problem of sleeplessness.现代制药学已经解决了失眠问题。

9 applied   

adj.应用的；v.应用，适用

参考例句：

• She plans to take a course in applied linguistics.她打算学习应用语言学课程。
• This cream is best applied to the face at night.这种乳霜最好晚上擦脸用。

10 savings   

n.存款，储蓄

参考例句：

• I can't afford the vacation,for it would eat up my savings.我度不起假，那样会把我的积蓄用光的。
• By this time he had used up all his savings.到这时，他的存款已全部用完。

11 rejection   

n.拒绝，被拒，抛弃，被弃

参考例句：

• He decided not to approach her for fear of rejection.他因怕遭拒绝决定不再去找她。
• The rejection plunged her into the dark depths of despair.遭到拒绝使她陷入了绝望的深渊。

12 Congressman   

n.（美）国会议员

参考例句：

• He related several anecdotes about his first years as a congressman.他讲述自己初任议员那几年的几则轶事。
• The congressman is meditating a reply to his critics.这位国会议员正在考虑给他的批评者一个答复。