Monday, February 27, 2017

I Am So Grateful For...Medicare, Medicaid, and Dialysis.

I read a horrifying headline today.  70% of people who need dialysis in India DO NOT RECEIVE IT.  

Without dialysis, of course, they die.  

There are a number of complex factors that are behind this.  Lack of availability, and cost.  Dialysis is one of the most expensive - and life saving - medical treatments there are.  It takes trained nurses, doctors and technicians, and of course, expensive machines and equipment. And depending on comorbidities and causes and the patient and their support system, a patient may be on dialysis for decades. 

In the early sixties I was a child, living across the street from another family whose father had kidney disease.  At that time the only facilities with dialysis machines were hospitals.  Treatments were costly and even if insurance covered it, it wasn't long before you reached your benefits cap and were left on your own.  I remember numerous fundraisers on that families behalf.  I remember that it was a big deal when the father did get a dialysis treatment.  It did not happen three times a week, like we have now, but maybe once or twice a month! I cannot recall exactly when he died, but it was before I was a teen.

In 1965 President Lyndon Johnson signed the act creating Medicare and Medicaid.  At that time those programs only covered retired people who were already drawing social security.  In 1972 Medicare and Medicaid were expanded to cover certain specific diseases that were particularly costly - and end stage renal disease, ESRD or end stage kidney disease, ESKD was one of those diseases.  At last, dialysis was completely paid for by the government starting when you reach the cap on your personal insurance.  

Dialysis is big business now, with several international companies vying to provide your dialysis, both in clinic and through home modalities.  But at least patients with ESRD in the United States can and do receive the dialysis they want and need without fear of losing it because you can't pay the (enormous) bill. You won't die because you cannot pay for a life saving treatment that you have to have every few days (or more often depending on modality)

Times have changed since 1972 and Americans are dying of other illnesses.  I wish our government would see fit to add more diseases to the automatically and fully covered portion of Medicaid and Medicare.  Cancer, for instance, and AIDS.  I'm sure you can think of many more, depending on what you have been exposed to through your family and friends.  In fact, I would really like to see us with a single payer system like so many other countries so nobody has to go without a treatment, surgery, or drug because of a lack of money or insurance.  This system is a long ways from perfect.

But I am so very grateful that we do have Medicaid and Medicare and they do cover dialysis for ESRD (or ESKD). 

I can't find the information on who spearheaded the movement to get Congress to expand Medicare/Medicaid for this purpose - but whoever you are or were, I cannot thank you enough.  And I'm sure I am not alone.  

India is making a great effort at this time to expand their ability to provide dialysis for their citizens.  I wish them all the best. 


Summer Foovay

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