I have been involved with dialysis for a very long time.  I was 8, when I decided I would invent an artificial kidney and become a chemical engineer.  If that were all I did, it could have been enough.  But, these were among the several dialysis innovations with which I am associated.  I am not trying to bore you with my history, but to present you with the background as to why I am writing about this now.

Dialysis was the first treatment therapy that the US government agreed to cover, regardless of patient age some 40 years ago (30 October 1972).  It is among the largest single expenditures of the Medicare program.  The ESRD (End Stage Renal Disease) program currently covers some 506,000 patients in the US- or roughly 1 in 600 Americans.  (In 1972, we thought the maximum population census would be 40,000.) In 2007, the program costs ran about $ 24 billion (and this has been about 6 %  (for many years) of the total Medicare costs of  $ 410 billion; this year Medicare is running about $ 450 billion, which means ESRD costs are approximately $ 27 billion this year).

If you are old enough, you may recall the original brouhaha about Death Panels.  In the 60’s and very early 70’s, only a few patients were afforded the ability to be treated with dialysis.  Back then, the treatment costs ran about $ 10,000 per annum (they are now set about $ 38,000), and there were not enough machines or specialists.  As such, anonymous panels were developed to screen applicants, determining who would or would not receive treatment.  There were documentaries on TV- Edwin Newman narrated one for NBC, pieces in Life and Look (the big magazines of the time), among other magazines- describing the ethical dilemma of who shall live (get dialysis treatment).  It became a societal issue; dialysis could not be a right just for the rich, privileged upper class.  Something had to be developed to change this situation. It should be crystal clear that this history should be studied in light of the “Death Panel” tizzy that seems to associate itself with America’s new health care system.

As if that is not enough of an appropriate reason, HHS (US Health and Human Services) has been developing a new methodology to reimburse clinicians and facilities for their dialysis services.  The new, prospective payment system, will become more outcomes-based, as opposed to the fee-for-service method that has prevailed for 4 decades.  (Our health care will become more outcomes-based, using evidence-based medicine.)

Obviously, we have a lot to discuss.  Stay tuned for more.

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