Kidney Dialysis: The Price of Government Monopoly

[okarol]

Friday, August 28, 2009

Kidney Dialysis: The Price of Government Monopoly   [John R. Graham]

USA Today has run an article describing the relatively dire state of kidney dialysis in America today.  Kidney dialysis is difficult enough, but it's also just plain inconvenient because patients have had to travel to dialysis centers at inconvenient times. Although it's possible to dialyze at home, 92% of patients are "treated in centers . . . not because it's optimal but because that is the way it has been done for nearly four decades."

The punch line? The U.S. government's Medicare program is the monopoly health insurer for patients who need the treatment. That goes a long way to explain why the protocol is frozen in time. Can you think of any medical specialty — cardiology, psychiatry, orthopedic surgery, etc. — where you can describe what's happening today as no different than four decades ago?

Unfortunately, the article gets the history wrong, stating that "when President Nixon signed the 1972 bill establishing the End Stage Renal Disease Program, only 10,000 Americans were on dialysis. . . . Only the wealthy could afford long-term tratment." USA Today wants us to believe that the government rescued dialysis patients from an awful fate.

The truth is different, according to a fascinating chapter by Richard A. Rettig in the book Biomedical Politics (pp. 176-214). Dr. Rettig reports that effective dialysis was an emerging technology in the 1960s.  The innovators founded the American Society of Nephrology in 1966 (p. 181).  "Nephrologists trooped to Seattle in the early 1960s to learn how to perform dialysis, and programs sprang up across the country, each growing over time as means were found to finance treatment." In the late 1960s, "there were fewer than 1,000 patients being dialyzed in the entire country, but that number had been increased to approximately 10,000 by the time the 1972 legislation was adopted" (p. 182)"

USA Today reports that there are 350,000 patients undergoing dialysis today. The overall population has increased by 45% (from 210 million to 305 million), so we can reasonably assert that the eligible population for dialysis in 1972 was about 240,000 patients. At the rate of growth prevalent until 1972, it would have taken seven more years, until 1979, for the private sector to cover everyone. But it's reasonable to assert with confidence that the pace would likely have accelerated as the technology was broadly accepted as effective.

So, things were actually progressing pretty well until the government crowded out private coverage.  I suppose dialysis patients were just unlucky, that significant medical breakthroughs were happening just as the government succeeded in its first phase of taking over Americans' access to medical services.

If President Obama achieves his goal of completing the government's take-over of Americans' access to medical services, expect every medical treatment available in 2049 to be (at best) unchanged from those available in 2009.

http://healthcare.nationalreview.com/post/?q=NjIyMzU0NTViNGViNzIzZTExYTk4MDM2ZmZjYWQ4NGI=

[Bill Peckham]

A couple things wrong with this history.

There was not 240,000 people needing dialysis in 1972. A lot has changed in the health of the US population. Diet, exercise and all that but another factor is that people are living to an older age. They're being saved of the heart disease to progress to dialysis.

But there is a bigger problem with his history and its relevance to today. The shift from non profit dialysis community based dialysis - as Scribner imagined in Seattle. Dialysis based on how the patient felt. To for profit dialysis imagined at the Brigham and based on the clearance of urea - a harmless, tiny and therefore easy to remove molecule.

What has frozen dialysis for 35 years is the profit locked into the provision of dialysis.

[Rerun]

A couple things wrong with this history.

There was not 240,000 people needing dialysis in 1972. A lot has changed in the health of the US population. Diet, exercise and all that but another factor is that people are living to an older age. They're being saved of the heart disease to progress to dialysis.

But there is a bigger problem with his history and its relevance to today. The shift from non profit dialysis community based dialysis - as Scribner imagined in Seattle. Dialysis based on how the patient felt. To for profit dialysis imagined at the Brigham and based on the clearance of urea - a harmless, tiny and therefore easy to remove molecule.

What has frozen dialysis for 35 years is the profit locked into the provision of dialysis.

YES!   

[Jie]

I just don't see that the private insurance can cover all these ESRD patients for a long term. A lot of patients cannot work and would not have private insurance.  If one works for small companies, the cost may be also a problem too.