What a Major Coverage Denial Says About Medicare's Future

“Medicare and Medicaid are not specifically looking to stifle innovation, but in the end it boils down to only so many dollars to go around,” said Chris Orestis, senior care advocate and CEO of Life Care Funding. “This country is so rich in technological innovation, and there are so many treatments and techniques you could make cases for. These programs are backstops; they’re not intended to get you anything and everything.”

Given the limitations of government funding, then, it may be necessary to keep the CED and other review systems in place. “CMS should be able to decide what it will and won’t cover by going through the appropriate processes,” Orestis said. “If they’re going to invest billions of dollars through reimbursements, they have a legitimate interest in reviewing a process for potential cost savings.”

Issues of cost and coverage aside, the CMS decision also contributes to concerns that growing government involvement in healthcare will ultimately limit innovation altogether. The FDA is often ridiculed for its own stringent review policies, and the CMS’s involvement in the approvals process now adds layers of complexity for medical manufacturers. “The CED program exemplifies the problems created when large federal bureaucracies excessively expand their regulatory power in the healthcare market,” said Winegarden. “Due to the adverse impact that the CED program is having on medical innovation and patient welfare, both a short-term and a long-term fix are necessary.”

Still, other health experts and senior advocates aren’t as worried about the future of medical technology. “Innovation will continue because there will always be a combination of private and public dollars to be spent on it,” said Orestis. “Medicare and Medicaid may have to be selective in what they can support, but the private market will always be there, and prices will be established by supply and demand.”

Of course, demand is consistently high among the nation’s growing population of seniors and dementia patients, and the supply of Medicare money isn’t keeping up. Treatments for Alzheimer’s and other forms of dementia may continue to improve, but current and soon-to-be retirees will need to set aside their own funds to ensure they have access when they need it. “Someone who relies solely on Medicare for their health coverage is just not going to get as good a coverage as someone with Medicare, Medigap, private life insurance and a long-term care policy,” Orestis said.