Wednesday, October 31, 2012

From Poder Magazine, Oct/Nov 2012
Life and Casualty
Ask not what your public hospitals can do for you but whether you have enough hospital days left for a life-saving procedure

By Kirk Nielsen

Your name is not Jim Kuhn but if it were you’d have died this past August, after doctors and hospital administrators failed to provide you with a heart pump, because your catastrophic coverage had expired.

We like to take comfort that America has “the best health care system in the world,” and it does have astonishing ways, like heart pumps and dialysis, to keep us alive. It also has astounding ways to kill us. In 2009, researchers from Harvard University and the Cambridge Health Alliance determined that 45,000 Americans die each year because they lack health insurance. That’s more than twice the number of American troops killed during the deadliest year (1968) of the Vietnam War. “The United States stands alone among industrialized nations in not providing health coverage to all of its citizens,” the researchers wrote. 

The kind of heart pump the 52-year-old Kuhn needed, according to Dr. Steven Borzak, his cardiologist at JFK Medical Center in West Palm Beach, is an amazing battery-powered gadget called a Left Ventricular Assist Device. The pump part is implanted in one’s chest and wired to a compact control unit worn like a shoulder holster.

As Miami Herald reporter John Dorschner wrote in the article that broke Kuhn’s tragic story, LVADs “were made famous when former vice president Dick Cheney received one as a temporary device before he received a heart transplant.” But cardiologists are increasingly prescribing the pumps in lieu of transplants. Dorschner quoted Duke University physician Dr. Joseph Rogers as saying “80-to-90 percent of patients with advanced heart failure die within a year without LVADs.” With them, however, patients show a 63-to-75 percent chance of surviving at least two more years, Rogers added.

The costs are daunting, of course. An LVAD sells for about $100,000. But that wasn’t the obstacle in Kuhn’s case, according to his doctor. LVAD manufacturer Thoratec agreed to donate one. The problem was that no one donated hospital days to Kuhn, a former truck driver. 

JFK Medical Center doesn’t do transplants, and when Borzak sought transplant specialists at the University of Florida’s Shands Hospital and at Miami-Dade’s Jackson Memorial Hospital, administrators at the two hospitals refused to admit Kuhn. The rationale: He’d used up his Medicare allotment of no more than five straight months in the hospital and had no private health care insurance. Florida’s hospital limit for Medicaid, for which he also qualified, is 45 days. “Borzak, the cardiologist, said no hospital wanted to implant the LVAD in an uninsured man,” Dorschner reported. In sum, Jackson and Sands left a very sick man to die over concerns about money. 

Like heart surgeries, LVAD installations are exorbitant. “The aggregate costs of such treatments can potentially become high enough to have adverse effects in other areas of social welfare,” bioengineer Kenneth Foster and three colleagues from the University of Pennsylvania concluded in a 2004 analysis. But they also wrote: “It is clearly unacceptable to deny patients a lifesaving treatment (such as dialysis or LVAD).”

The price of extending a life with an LVAD remains high, but is decreasing. A Duke cardiology study published this year estimates the average five-year cost for LVAD treatment to be $360,000. “If I were dying from heart failure I would certainly want to have an LVAD,” Foster told me recently.

Two days after Kuhn died Jackson Health Systems projected a $35 million surplus for the fiscal year that started Oct. 1, after being deep in the red in recent years.

And with the help of bond money, “Jackson leaders hope to plow $63 million into capital improvements,” the Miami Herald article noted.

A small fraction of that $98 million—or even tinier fractions of the billion dollars in fraudulent Medicare payments that made their way to South Florida in recent years, or the billion dollars sunk into a baseball stadium—would have covered LVAD costs for Kuhn and many others. 

JHS’s new budget also includes $1.5 million in marketing and advertising. What a shame. Because no commercial could ever send a more powerful message than a news story about surgeons defiantly giving Jim Kuhn a heart pump regardless of his insurance coverage. 

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