Smart, cost-effective health care

Congress has the perfect opportunity to promote smarter, more cost-effective health care. “The Access to Innovation for Medicare Patients Act” will set a strong precedent for modernizing Medicare and provide millions of Americans who suffer from rheumatoid arthritis, multiple sclerosis and other diseases with immediate access to better medical treatments. This bill could save taxpayers money in the long run as well by preventing the need for more costly medical treatments.

The practice of medicine has changed dramatically since the Medicare program was created more than 35 years ago. Arguably the greatest change has come from the development of new medicines. Once chronically and severely impaired people can now be treated. To the greatest extent possible, our public and private health programs need to ensure that these treatments reach the people who need them the most.

In recent years, a number of highly effective self-injected treatments have been developed for several severe diseases, including multiple sclerosis, deep vein thrombosis (blood clotting), and hepatitis C. It makes sound medical and economic sense to enable Medicare patients to have access to treatments that will keep them out of the hospital, prevent their illnesses from getting worse, and help them remain active members of their communities.

Rheumatoid arthritis provides a good example of a serious disease that is responding to new self-injected treatments. Rheumatoid arthritis also happens to be an illness that I know a fair amount about not only from my training and years of practice as a licensed registered nurse, but also because a family member and dear friend suffer daily with this disease. A devastating chronic illness, rheumatoid arthritis brings pain and debilitation to its sufferers, who are primarily women. It is an autoimmune-related disease in which the immune system wages war against the body’s joint tissue. Healthy, flexible joints become swollen, dysfunctional, and extremely painful. Within 10 years of diagnosis, the majority of patients with the disease are severely impaired, unable to work or even care for themselves. Simple daily tasks like buttoning a shirt or zipping a zipper become impossible.

Until recently, the best treatment for the disease included steroids, anti-inflammatories, chemotherapy drugs and other medications that can produce grave side effects, such as kidney and liver disease, bleeding ulcers, and bone marrow suppression. While these treatments can provide some relief, they do not actually stop the progress of rheumatoid arthritis.

However, a new self-injected treatment called etanercept (marketed under the name “Enbrel”) does exist that not only relieves pain and improves mobility, but actually inhibits the progress of the disease. For many sufferers of rheumatoid arthritis, this treatment has turned their lives around. Thousands of older Americans who suffer from this disease could find substantial relief by using Enbrel, but they cannot afford the treatment out-of-pocket, and Medicare will not cover it.

Both my family member and my friend now take Enbrel as a drug therapy for their rheumatoid arthritis and it has been thrilling to watch them be able to resume more of their normal and independent lifestyles. Yet at the same time I am saddened to know that there are thousands of other rheumatoid arthritis sufferers who could be helped by this prescription, yet have to continue to suffer in daily pain.

Some might argue that Medicare has to draw the line at expensive treatments. Enbrel costs approximately $1,000 to $1,250 a month. Yet Medicare will cover expensive surgery, hospital and nursing home care that often results when rheumatoid arthritis progresses unchecked. Medicare will even cover medications taken in a hospital or clinic, but not self-administered injections, such as Enbrel.

This is a double whammy to those of us who live in rural areas of Maine like my friend who lives in Rangeley and sees a medical specialist in Farmington. Why should she and others like her be required to spend the better part of the day traveling to and from their home to a clinic, hospital or doctor’s office when the medicine needed has been designed to be self administered at home?

It may be some time before we get a complete overhaul of Medicare, but Congress and the President have a golden opportunity to make a quick, smart fix in the system. “The Access to Innovation” bill is a good first step in reforming the Medicare system so that it can better help older and disabled Americans. This bill will provide Medicare coverage to patients using new self-injected treatments – often the best treatments – like Enbrel.

Luckily, here in Maine our senators and congressmen are supporting this change to Medicare rules. The nation just needs more members of Congress like those in Maine has wisely sent to Washington. The quality and health of many Americans’ lives depend on it.

Zenna Inness of Rangeley is now retired after a career as a certified school nurse in South Portland.