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Fact or fiction? Medicare is already rationing

Claim: Medicare's cost-driven rationing of medicine has caused hundreds of deaths.

In the Senate debate last week, Sen. Tom Coburn, R-Okla., a doctor, said the Centers for Medicare & Medicaid Services (CMS), which runs Medicare, decided in 2007 to ration use of anti-anemia drugs such as Epogen. The Food and Drug Administration had determined that use of such drugs increased the risk of death in some patients. The decision to limit reimbursement  was appropriate in many cases, Coburn said. "But it totally ignores the other 25 percent of the patients who happen to have complicating factors, such as congestive heart failure…." He added, "I cannot tell you the number of people who die from the CMS regulations on Epogen for oncologists. But there were hundreds -- hundreds -- because Medicare never looked at the patient; they looked at dollars." Coburn contends that the CMS action is a precursor to the kind of rationing the government will do if the Democrats' bill passes.

Fact or fiction?
Unclear. CMS decided in 2007 that, based on the FDA warning and other research, Epogen and similar drugs were "not reasonable and necessary" for some Medicare patients. CMS said the cost saving for Medicare was "not a consideration." But Coburn said last week that CMS was "seeing too much money going out the door" on Epogen and similar drugs. He contended that CMS would never admit that the decision was made for cost reasons. "You have a (Medicare) bureaucracy making the decision," he said, adding that CMS "made a clinical judgment without the knowledge of the condition of the patient." Emphasizing that the policy was made during the Bush administration, Health and Human Services Department spokesman Nicholas Papas said, "The policy implemented by the previous Administration helps ensure Medicare covers the safe, appropriate use of these medicines."

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