ProPublica lifts the lid on renal dialysis in the US

Nearly 40 years after Congress created a unique, universal health care-like entitlement for patients with kidney disease, U.S. death rates and per-patient costs are among the world's highest while two big for-profit chains dominate the dialysis business.  

ProPublica's senior editor Robin Fields conducts an investigation into the flawed federal system governing kidney dialysis and finds taxpayers footing a $20 billion a year bill for a program that allows 1 out of 4 patients to die within a year.

Fields' examination, co-published today in the December issue of The Atlantic magazine, shows:

* how some treatment centers are run like factories with poorly trained personnel in filthy, disease spreading facilities;

* how "Medicare has struggled to enforce quality standards for dialysis while meeting its prime directive of providing universal access." 

* why the government has not made key metrics and data availalble even though that information could help patients choose better care options.

* why it became an entitlement during the Nixon Administration when hospitals had "god committees" (aka death panels) that determined who got treatment and who didn't because the cost was so expensive;

* And how a country like Italy has better care that yields better results - with one of the lowest mortality rates at a cost of about one-third less than we spend per patient.

Fields notes, "The government's payment policies for dialysis have created financial incentives that, in some ways, have worked against better patient care, while enabling for-profit corporations to dominate the business."  Today, more than 80% of the nation's 5000 clinics are for-profit and almost two thirds of all clinics are operated by two chains.  And Fields goes on to explain how the business models have changed to work to the for-profits' advantage now.

The investigation includes a graphic that explains how dialysis works and other special features.  This investigation is the first in a series of reports that will come out over the next few days.