America’s Medicare dialysis program, once seen as a triumph for the masses, has become a “hulking monster,” writes Robin Fields in an exhaustive ProPublica investigation. Since 1972, treatment has been provided, through Medicare, for virtually anyone with kidney failure, regardless of age or income. Today, the US spends $20 billion a year on dialysis care—more, per patient, than any other nation—yet has among the highest mortality rates. To find out why, ProPublica interviewed more than 100 patients, doctors, and researchers, and pored over thousands of documents. It discovered a bleak picture: Clinics are largely unsanitary, and feature few quality controls.
There are almost no staffing requirements, so doctors are rarely on site. There are no incentives for positive outcomes, so patients are cycled in and out with brutal efficiency. Regulators are powerless to fine lackluster institutions, as they do nursing homes, and the two companies that control 80% of all dialysis clinics routinely rake in $2 billion a year in profits. Part of the reason none of this has become a national outrage: Kidney failure disproportionately afflicts minorities and the poor.