What could be more likely to draw international headlines, and jokes on late-night talk shows, than a government report that includes both an alleged waste of Medicare money and erectile dysfunction?
Even without dopey jokes about swelling costs and rising whatevers, this story was bound to get attention: The federal Department of Health and Human Services dispatched its Office of Inspector General to review Medicare payments for vacuum erection systems, less formally known as penis pumps. Its recent report revealed that Medicare was paying “grossly excessive” prices for these devices (which draw blood into the penis, creating an erection that allows a man to have intercourse).
From 2006 through 2011, the investigators found, Medicare paid on average $451 per pump. Medicare beneficiaries were responsible for a $90 co-pay; Medicare put up the remaining $361. That was more than twice what the Department of Veterans Affairs paid per pump: $186. Searching online, the investigators found that consumers could buy similar pumps for even less.
And Medicare paid for a whole lot of these items — more than 473,000 pumps over six years. Had it paid what others paid, the Inspector General’s report concluded, taxpayers could have saved more than $14 million and beneficiaries almost $4 million each year.
Those are paltry sums in the general scheme of Medicare, which spends hundreds of billions of dollars annually. But anyone who wants Medicare to continue to provide health care for older and disabled Americans, and avoid death by a thousand budget cuts, had to shudder at the waste.
The Centers for Medicare and Medicaid Services pointed out that it had made significant progress in reducing overpayments for durable medical equipment (which is what a vacuum erection system is) with its competitive bidding program. But the agency needs Congressional authorization to add pumps to that program, as the Inspector General suggested. Officials said they would consider seeking it.
Aside from the price tag issue, though, there is rumbling about whether Medicare should cover penis pumps at all.
According to Reuters, a senior fellow at the Heartland Institute (which advocates “free market solutions”) pointedly noted that retiring boomers will strain the Medicare budget and asked if politicians shouldn’t “be focusing this entitlement program on real, life-saving treatment and equipment to service the health needs of seniors?” For men who wanted a pump, he added, “just buy it yourself — you don’t need to send the bill to your fellow Americans.”
The comments on mainstream news sites were predictably nastier, with contemptuous references to “geezers” and “old goats.”
“We are a laughable bunch as we spend that sort of money to allow sexually dysfunctional men to have erections they have no business having,” read one of the milder comments on the NBC site.
There is an ageist current here, a result of our deep discomfort with the idea of older people’s sexuality. Can’t we insist that Medicare not get ripped off by device manufacturers without sneering at the idea that an older man — perhaps feeling the effects of diabetes or the side effects of prostate cancer treatment –- and his partner might want to have intercourse?
Most private health insurers cover vacuum pumps, and many also cover drugs like Viagra, Levitra and Cialis to treat erectile dysfunction. Why should that approach change on someone’s 65th birthday?
“The general concept is that older people are asexual, that they don’t have, or shouldn’t have, any thoughts about sex,” said Ann Christine Frankowski, associate director of the Center for Aging Studies at the University of Maryland, Baltimore County, whose research has included sexual behavior and policies in assisted living. “There’s a bias against it.”
In 2006 Congress barred Medicare from covering medications like Viagra under the Part D drug plan. The bill’s chief sponsor scoffed at “Grandpa’s recreational sex” — his language suggesting that if he couldn’t avoid paying for seniors’ health care, he at least wanted to be sure they didn’t have any fun.
In fact, beneficiaries’ increased use of vacuum pumps for impotence may well be a response to the fact that Medicare won’t cover the pharmaceutical treatments, which are considered “first-line” therapies. “They’re the most patient-friendly,” said Dr. Ira Sharlip, a urologist at the University of California, San Francisco.
The pumps, by contrast, are “a little awkward, a little inconvenient and not very romantic,” Dr. Sharlip said. “But they do work pretty well, and a lot of patients rely on them.”
Medicare covers many things that don’t save lives but do enhance health, as it should. And of all the things it doesn’t cover, we might rank dental care well ahead of penis pumps or erectile dysfunction drugs in importance.
But it is hardly ridiculous to think people over age 65 are doing it. In fact, as a recent New York Times opinion piece by Dr. Ezekiel Emanuel pointed out, more than half of men and 40 percent of women over age 60 are sexually active (and, sadly, not using condoms regularly enough to prevent sexually transmitted diseases).
My two cents (and I’m eager to read yours): Sexual health is part of health. And you can spare us the ageist claptrap about Grandpa and his recreation, sonny.
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.