By John Ballard
End stage renal failure provides an instructive lesson in what happens when government writes a blank check to the private sector. The motives are pure but the consequences may be more than we can afford.
Carol Levine directs the United Hospital Fund's Families and Health Care Project, which focuses on developing partnerships between health care professionals and family caregivers, especially during transitions in health care settings. Ms. Levine is the editor of Always on Call: When Illness Turns Families into Caregivers and, with Thomas H. Murray, co-editor of The Cultures of Caregiving: Conflict and Common Ground Among Families, Health Professionals and Policy Makers.
The Seattle �God Committee�: A Cautionary Tale tells the story of a government program with good intentions now costing far more than expected. Started in the early Seventies, Medicare funding for ESRD now supports a thriving, profitable segment of the economy. "About 80% of all dialysis centers are for-profit organizations."
The Medicare ESRD program has unquestionably prolonged lives. It has also grown far beyond the original estimates � from about 11,000 patients in 1974 at a cost of $229 million to about 527,000 (including post-transplant patients) in 2007 at a total cost of $23 billion. While the original users were mainly patients with polycystic kidney disease (a genetic condition), now the majority are patients with renal failure caused by diabetes and hypertension. Some patients who are unlikely to benefit from dialysis�dying patients in the last few days of life � are getting it anyway. Critics now contend that the dialysis program is too costly and needs updating.
Here is a calm look at the kind of decision-making needed in the years ahead as we confront, with or without further legislation, the growing costs of health care.
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