It’s November- which means the big research about dialysis is discussed.
The ASN (American Society of Nephrology) meeting was one of the highlights of the year (about the same time as the annual meetings of the AIChE and ACS [American Institute of Chemical Engineers and the American Chemical Society])- plus the May meeting for ASAIO (American Society for Artificial Internal Organs) that provided lots of great opportunities to learn and network for me. (As I got older and could more easily travel overseas, the EDTA [European Dialysis and Transplant Association] garnered my attention, too.)
By the time I was a teenager, it was clear how much dialysis had advanced. With the first glass-blown device (Abel, Roundtree, and Turner, 1914) to Pim (Willem) Kolff’s ‘washing machine’ device in 1944 to the development of vascular access (Belding Scribner and Wayne Quinton, Washington State) in 1960. Those were the underpinnings of the field as I became interested. By 1965, there was an artificial kidney/chronic uremia program at NIH and the Public Health Service had started a kidney disease control program. George Schreiner (Georgetown) (the founder of ASAIO and ASN) and John Merrill (Peter Bent Brigham Hospital and Harvard) – along with Scribner and Kolff were the “big four”- the names inimically entwined with dialysis by the early 1960’s.
Dialysis was still a unique concept, but one gaining traction as a means to keep folks alive as their kidneys failed. The dialysis centers of note were the Seattle Artificial Kidney Center, Hennepin County Regional Kidney Disease Program, and the fledgling Boston Kidney Center (pulled away from Peter Bent Brigham, becoming National Medical Care and eventually Fresenius) were dealing with dialysis on a daily basis. By 1973, patients no longer had to pay for dialysis- it was a covered event under Medicare Part A (in-center) and occasionally under part B (home dialysis). (Wilbur Mills, the legendary head of the all-powerful Ways and Means Committee) and Russell Long of the Senate Finance Committee used their considerable powers to ensure the passage of the Medicare modifications. Adding to that “environment” were two competing proposals- one from the infamous Richard Nixonwith his National Health Insurance Partnership Act of 1971, deliberately set to counter Senator Ted Kennedy’s proposal on national health insurance.)
But, in 1972, in terms of indirect costs of mortality, kidney disease was the highest ranking killer- $ 1.5 billion annually. Those numbers were for 55K patients, of which about 25,000 were prime dialysis candidates. While annual dialysis costs were well known to run at $ 25K to $ 30K [please consider one other medical procedure that has maintained a constant annual treatment cost over 40 years– and these numbers are NOT adjusted for inflation], it was the explosion in the number of patients that proved to be the big driver in expenditures.
The proponents of government funding for dialysis had no idea how Congress and the regulators would react over time. In essence, their desire to control costs did nothing to improve the quality of life for patients. As a matter of fact, it actually led to increased government costs.
Tomorrow, we’ll consider one such consequence.
