The federal government is looking for ways to save tax dollars and one way is to encourage those with ESRD to enter hospice rather than go on dialysis. Congress established this "entitlement" program In 1972 when treatment options for End Stage Renal Disease were limited. According to the New York Times,
dialysis and transplants were new procedures that were not covered by health insurance. There were horrifying stories — rich people got dialysis and lived while poor people died.
A bit of class warfare that decides who lives and who dies.
Now Congress is looking for ways to save money and one way is to encourage those on Medicare to just go ahead and take one for the team.
at that time (1972) fewer than 40 patients per million would need dialysis, and that most of those patients would be healthy — except for their failed kidneys — and under age 54.
Now more than 400 people per million start dialysis each year. More than a third of the patients are 65 or older, and they account for about 42 percent of the costs. People over 75 make up the fastest-growing group of dialysis patients. And most elderly dialysis patients have other serious diseases like diabetes, heart failure, stroke and even advanced dementia. One-third of them have four or more chronic conditions.
Unintended consequences . . .
Recent studies have found that dialysis does not prolong life for many elderly people with other serious chronic illnesses. One study found that the procedure’s main effect is to increase the chances that such patients will die in the hospital rather than at home.
Save tax dollars. Send grandpa home.
A committee of the Renal Physicians Association recently formulated guidelines to use in deciding when dialysis is appropriate. It provides questions that doctors should ask themselves before suggesting the treatment. One is the “surprise” question: Would I be surprised if this patient is dead within a year?
Well that is certainly comforting!
Don't be surprised if Congress doesn't come up with a way to encourage dying over dialysis.