Administration health leaders were accused yesterday of letting children who need life-saving liver transplants die by terming the operations "experimental," a label that lets many insurers refuse to pay for them.
An official of the congressional Office of Technology Assessment also accused administration health officials of refusing to pay for Medicare heart transplants on grounds that they too are experimental, though more than 100 were done in the last year.
Both Medicare and the Defense Department's CHAMPUS program, which covers military dependents' care when it is unavailable in military hospitals, pay for kidney transplants but not liver transplants.
"You not only allow children who need liver transplants to die, you're wasting taxpayers' money" since the operations are cheaper than the medical care during their "living deaths," Rep. Albert Gore Jr. (D-Tenn.) told four top health officials.
Liver transplants cost $80,000 to $175,000 and have reached $300,000. Heart transplants cost $60,000 to $100,000.
The government was defended by the four officials at the hearing, the Department of Health and Human Service's assistant secretary for health, Edward N. Brandt Jr., Surgeon General C. Everett Koop, Health Care Financing Administration (HCFA) Administrator Carolyne K. Davis and the Defense Department's acting assistant secretary for health affairs, John F. Beary.
They told Gore's House Science and Technology investigations and oversight subcommittee there have been no long-term asessments of whether liver transplants are wise procedures offering normal growth and an infection-free life. They said national Blue Cross-Blue Shield still calls them experiments, though some state "Blues" plans are paying for them.
The officials promised an up-to-date assessment at a June conference, followed by a decision this summer on the operations' status.
Gore called the officials' position "unreasonable," "intolerable" and "absurd." Although recent statistics indicate that some 70 percent persons receiving liver transplants live for at least a year, Gore said, decisions are "frustratingly" slow.
"At least two" children of military families have died while awaiting livers, he said, "principally because they were unable to pay" and CHAMPUS would not.
His charges of dawdling were supported by Dr. H. David Banta, the OTA's assistant director for health and life sciences.
"I don't know enough about liver tranplants to say whether they should be covered by insurers ," he said, but "I think your pointing a finger" at government slowness is "exactly right."
He said Congress in 1978 created a National Center for Health Care Technology in HHS to help decide whether to pay for new programs. But administration budget cuts killed the center, he said, leaving only a "remnant" and "really inadequate" programs for assessing new technologies.
"Perhaps the most distressing case is that of heart transplant," he said. "The National Center for Health Care Technology recommended that it be covered at selected centers in February, 1980. It is still not covered."
HCFA's Davis said her agency has financed nine heart transplants and will finance five more in a study now near completion.
But "one is left with the impression," Banta said, "that HCFA is delaying payment for cost-containment reasons," and if this is true, it is "a serious perversion" of technology assessment.
He also said the matter of costs, even though great, should be left to the nation's social and political decision-makers.