Medicare Should Distinguish Between Impotence and “Non Medical” ED

How do I put this delicately?  As men—-age—they may find that their—prowess—can’t be as frequently—expressed—as when they were young bucks.  But we live in an age in which a certain demographic—mine, actually—is targeted for drugs and equipment to allow us to—perform—as if we were 18. A new term was popularized—you’ve all seen the commercials—called ED.

It has always seemed to me that ED was not the same as illness-caused impotence.  It is sometimes a lifestyle desire issue, not a true illness.  Or to put it another way, ED remedies are often provided to 65-70 year-old men because they are 65-70 year-old men.

I bring this up because in Medicare is pouring billions into pumps to help older men do that voodoo that they want to do so well.  From the Heartland Institue story:

According to data collected by the Centers for Medicare and Medicaid Services (CMS), Medicare has spent more than $240 million of taxpayer money on penis pumps for elderly men over the past decade, and will surpass a quarter of a billion dollars this year for costs since 2001. The cost to taxpayers for the pumps more than quadrupled during that period, from a low of $11 million in 2001 to a high of more than $47 million in 2010. And these represent only the costs for external devices, technically classified as “Male Vacuum Erection Systems,” not implantable devices or oral drugs such as Viagra

If we are going to cut costs in health care, it seems to me we start at being more discerning about paying for “treatments” that border on lifestyle desires rather than medical maladies—especially when we are already restricting payment for needed efficacious treatments like life-extending cancer drugs for terminal patients.

Now, I understand that impotence can be medically caused by, say, diabetes or prostate surgery.  But I don’t think a man who can physically dance the samba—just not as often as he would like—or who can’t because he is worried he won’t be able to hear the music—meaning a psychological issue—or because he is stressed, etc., should be covered by Medicare in the same way as a man with a true disease.

And it appears that Medicare doesn’t much distinguish between true impotence and what I will call for the purposes of this discussion, non medical ED:

The National Institutes of Health previously estimated between 15 percent and 25 percent of 65-year-old men experience ED on a long-term basis, which the LCD notes may be caused by “diabetes, other endocrine abnormalities, vascular abnormalities, trauma, neurogenic, psychogenic, side effects of many medications, and other causes.” The Cleveland Clinic also points to “psychological factors, such as stress, depression, and performance anxiety” as possible causes.If a medical exam and history shows a senior on Medicare meets the relevant threshold—a diagnosis of ED—he becomes eligible for a wide range of options under the Medicare Prosthetic benefit. Treatment Options covered by Medicare include “oral medications, pharmacological injections, intra-urethral suppositories, vacuum erection devices, and implantable penile pumps.”

But are these devices really “medically necessary”? Health Care News contacted CMS to ask whether they have audited the medical files to determine medical necessity. CMS has not provided a response at the time of publication.

Fraud is, apparently, a big problem:

One area of concern for CMS is the rise in fraud in relation to the pump devices. Earlier this year an Illinois man pled guilty to collecting more than $2 million from Medicare in a fraudulent operation where he repackaged $26 items from adult websites and sold them to seniors as medical devices, charging Medicare $284 apiece. Device fraud has become an increasingly common way for criminals bilk the taxpayers. Durable medical equipment (DME) is widely perceived as a “high risk” area for fraud, according to a spokesman for the HHS Office of the Inspector General.  And a report released last month by CMS found the error and improper payment rate for DME was above 60 percent, whereas no other area even entered double digits

Every time I am asked by media about the need to ration, I reply that IF we have to ration, we should start on those who need health care the least, not the most.  We also need to more effectively distinguish what is truly a medical malady from a lifestyle desire issue.  There can be little doubt that at least some of this Medicare expense is going to fund the latter.  This should stop.  The normal physiological changes that come with age should not be considered an illness.

Frankly, I am one who thinks men should pay for their own Viagra whatever the cause.  But this is particularly so if there is no clear medical reason for impotence, but the man wants a confidence booster or wants the pill or pump so that he can perform like he has the sexual energy of a randy teenager.  A lot of this would go away if mature men ignored the ads and acted their age.