Valuing Lives: The Policy Debate on Patient Care Financing for Victims of End-Stage Renal Disease.

摘要

In Public Law 92-603, the Social Security Amendments of 1972, Medicare health insurance coverage for end-stage renal disease was effectively extended to more than 90 percent of the U.S. population. The 1965 law which established Medicare provided health insurance coverage to the aged--those over 65 years of age, and this included coverage for renal failure. Public Law 92-603 provided Medicare coverage to the under-65 population who qualified for cash benefits under social security or the railroad retirement system because of a disability. This protection included coverage for endstage renal disease. A substantial number of potential end-stage renal disease patients, approximately 60 percent of the total, however, could not qualify for Medicare on either the basis of age or entitlement to cash disability benefits. Medicare coverage was extended to this larger group by Sec.299I of the Act and included those who were medically determined to have chronic renal disease and to require hemodialysis or renal transplantation. What is the significance of Sec. 299I. Part of its significance lies in the extension of Medicare coverage for end-stage renal disease to the U.S. population on a near-universal basis, both by virtue of its own coverage and by highlighting the benefits available to the aged and disabled. It is also significant because it is a concrete instance of the willingness of the national legislature to pay a very substantial price to preserve the lives of a very small number of individuals.