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Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on March 05, 2010, 09:08:44 PM
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Health care comes down to cases of Oregon wine for mother who has insurance, needs kidney -- and money for anti-rejection drugs
By Andy Dworkin, The Oregonian
March 05, 2010, 7:24PM
kidney_9.JPGPHOTO COURTESY DOREEN WYNJA Lupe Hernandez got a kidney transplant Feb. 25. Although she has insurance, she had to raise at least $15,000 to cover the cost of transplant drugs before she could have the transplant. Much of the money was raised by selling special wines bottled by Eyrie Vineyards, here her husband, Julio, works. The family is pictured here in Eyrie's original vineyard in the Willamette Valley. This is a story in a bottle about the fractured U.S. health care system, where a mother's ability to get vital surgery depends on 316 cases of Oregon wine.
Guadalupe Hernandez is 28 years old and a mother to three girls, 4, 6 and 8. She lives in Amity with her husband, Julio, cellar manager at Oregon's pioneering Eyrie Vineyards. For years, pregnancy-related high blood pressure, probably worsened by an underlying infection, attacked Hernandez's kidneys, until they kept just 4 percent of normal function.
"My kidneys were shrinking, getting like a raisin, smaller and smaller," she said.
A transplant would vastly improve Hernandez's health and free her from the daily dialysis that cleans her blood. She has two insurance plans, Medicare -- which covers most kidney failure patients -- and the Oregon Health Plan.
Still, doctors told Hernandez she must raise at least $15,000 before she could have a new kidney. While her insurance covers a transplant, it won't pay for all the medicines needed to keep her body from rejecting the new organ.
"They said there was no point in doing a transplant on me if I couldn't take care of the kidney," Hernandez said.
Eyrie insures its workers, but winemaker Jason Lett said the small business can't afford to cover their families. To help Hernandez, Lett mixed some of his reserve Black Cap wine with 2006 and 2008-vintage Eyrie, crafting rare nonvintage wine labeled La Luz, Spanish for "the light." He bottled 261 cases of pinot noir and 55 cases of chardonnay. Such bottles would normally sell for $65, but Eyrie and local stores are pricing them around $35, with much of the proceeds going to Hernandez.
If people bought enough wine, Hernandez could get a new kidney.
The wine-for-kidney deal may sound strange, but it's not so bizarre in the transplant world. As health care grows ever more costly, incomplete insurance coverage and a weak economy are forcing people to find creative ways to pay big health costs.
"We're definitely seeing more and more patients that are having to raise some money or do some financial planning to be financially ready for a transplant," said Lisa Morrison, financial counselor for Legacy Transplant Services in Portland.
"It's one thing to work and have a job. It's another to be able to afford and use your health insurance."
The trend is nationwide, said Rebecca Carr of the National Transplant Assistance Fund, which helps patients raise money for transplants and major trauma care. The nonprofit offers advice on hosting golf tournaments, dance parties and other fundraisers, and handling the money raised for patients. The group is now working with about 1,200 people, including Hernandez. Carr said the need to fundraise for transplants has shot up the last four years.
The crazy finance of kidney failure frustrates Dr. William Bennett, a Legacy nephrologist. He said transplants are generally better than dialysis, not only for patients' health but also the nation's budget.
Medicare spends about $71,000 a year for a patient on dialysis, according to the National Kidney Foundation. The government health plan spends an average of $106,000 on a transplant, plus $17,000 a year for drugs to prevent organ rejection, which a patient must take for the rest of her life. So a transplant saves money over dialysis during the second year.
But Medicare only covers 80 percent of transplant drugs, and stops paying entirely three years after the transplant, though the plan will cover dialysis for a person's lifetime. So some patients who can't afford to pick up the remaining drug costs stay on dialysis. And private insurers sometimes reject transplant patients, knowing Medicare will absorb their dialysis costs, Bennett said.
"The transplant patient always lives longer and has a better quality of life than the dialysis patient," he said. "It's the preferred form of treatment and it's cheaper, but it's hard to get done."
Legislators have discussed expanding the transplant drug coverage, but it's not clear if that idea will be included in the final health reform bill Congress is considering.
Today's transplant system reminds Bennett of the years before Medicare covered kidney failure, when surgery was so expensive and kidneys so rare that doctors would sit around a table and ration out organs. In the quest to find the best patients, divorcees might be rejected as socially unstable, or diabetics as unfit, he said.
"Now we're being put back in that position, as health care costs have escalated, about trying to decide, between individuals, about who gets what," Bennett said.
The system also frustrates Lett. He competes in an international business, mostly against wineries in countries with national health care plans, whose owners don't worry about insurance costs. But Lett spends at least a week each year reading insurance documents to find a decent plan he can afford to offer his workers.
"The inefficiency of the whole thing is what really bothers me," he said.
Hernandez's story may end well. Last Thursday, after nearly two years on a waiting list, doctors found a suitable donor and transplanted a new kidney into Hernandez. By the next day, Bennett said, her kidney function was nearly normal.
"I do feel better. I'm less tired, and up and walking around," Hernandez said Wednesday, shortly before leaving the hospital.
Hernandez isn't out of the woods. The transplant left her diabetic, and she must learn to care for that illness and her new kidney. There's a 5 to 10 percent chance Hernandez will reject her kidney within a year, though by tweaking drug treatments doctors can reverse most rejections, Bennett said. If she makes it through the year, Bennett said, the average deceased donor kidney lasts for a decade.
Fundraising is going well. Eyrie held a vintage chardonnay tasting and sale to help Hernandez; one "complete vertical" of 38 bottles from 1970 to 2007 is being offered for $7,500. Buyers have snapped up half the La Luz pinot and most of the chardonnay. Other vintners donated magnums to a dinner auction held a week ago at Dundee's Farm to Fork restaurant. That event put the donations past the $15,000 mark, but Lett will keep raising money for the pricey transplant drugs.
"We're going to make sure that Lupe has a good future," he said. "that her children grow up knowing her."
Andy Dworkin
http://www.oregonlive.com/health/index.ssf/2010/03/health_care_comes_down_to_case.html