Monica Yant Kinney: Policy saves life, then risks it

In 2003, Leonard Porter received a kidney transplant. After he recovered, he felt so good he resumed a grueling job in construction.

"With a healthy kidney," recalled Porter, 40, of West Philadelphia, "I got my life back."

But maintaining that quality of life hinged on taking medication that tricks Porter's body into thinking his brother's kidney is his own. Those two antirejection drugs can run $3,000 a month.

Medicare picked up 80 percent of the cost, but only for three years.

Porter swallowed his last pill in June, wept, and waited. Last weekend, feeling fatigued and bloated, the once-robust bricklayer checked into a hospital.

Porter's perfect kidney was failing, thanks to a health-care system that conspired against him.

"I can't believe they'd give me a kidney and not help me keep it," he said, angrily. "What's the point?"

Porter's doctor asks the same question every day, especially as politicians rail against a public health-care option.

"When you transplant a patient, you adopt them," explained Serban Constantinescu, a nephrologist at Temple University Hospital. "When you adopt someone, don't you have a moral obligation to cover their medication?"

The government got into the kidney business in the 1970s after Congress decided that Medicare would cover end-stage renal disease regardless of age or income.

"We have this funny version of national health insurance - if you have this one condition," said Robert Field, a Drexel University professor of law and public health.

But what's funny about a system that forks over $100,000 for a kidney transplant, then sticks recipients with a $36,000 annual prescription bill? When the organ fails because a patient stops taking medication he can't afford, Medicare happily picks up the $71,000-a-year cost of dialysis - for life.

Cost-cutting that leads to double the spending hardly makes sense, Field noted, "but I don't think anyone sat down and said, 'Let's make an idiotic decision.' "

Yet the idiocy ensnares patients like Porter all the time.

He earned too much for Medicaid, but isn't married and didn't have workplace insurance. For a while, Porter spent half his paycheck on private secondary coverage.

"I dropped the policy when I could no longer afford it," he admitted. "But then I couldn't find another insurance company to take me."

The better Porter felt after his kidney transplant, the more he realized his life depended on medication beyond his reach. Eventually, the father of three was reduced to begging for drug samples.

"We see this Catch-22 all the time," said Jacqueline Silver, a Temple transplant social worker. "If your kidneys are working fine, you're not sick anymore. But they're only working fine because of the medicine."

Porter was encouraged to go on welfare so he could get the pills he needed for free. He refused out of pride and principle.

"Welfare might pay for my medication, but it's not going to pay my rent," he said. "I'm a single parent. I'm a taxpayer. I need to work, and I need to keep this kidney."

"I'll pay for the pills," he pleaded. "I just can't pay for all of it."

In June, Porter lost his job and apartment. He rationed his medicine until it was gone.

"At that moment," Constantinescu said, "the battle to save the transplant is lost." Porter's body began fighting the foreign kidney, though it took weeks for him to notice.

"I knew the kidney was damaged," the shamed man said, "but I thought maybe they could save it."

Constantinescu assured Porter he was not to blame and vowed to put him back on the transplant list.

Porter is scared and skeptical.

"I would love to get another kidney," he said, "but only if I can get help with the medication."

He already had his heart broken once. Another failure may kill him.