Connections: Profits in Health Care

End-stage kidney disease is the only chronic disease whose treatment is paid for by the United States government

   When The New York Times reported last week, on the front page, that a major lobbying effort was being made to reinstate a proposed cut in payments to dialysis centers, and that 205 members of Congress had asked that the cut be eliminated, my attention was riveted. Ev Rattray, the editor and publisher of this newspaper and my husband, who died more than 32 years ago, was a dialysis patient in the last years of his life, after cancer claimed both his kidneys. That was a long time ago. Although I knew there were clinics now much closer than Bay Shore, to which he traveled three times a week until we were able to do dialysis at home, I somehow wasn’t entirely aware that profit-making centers had sprung up around the country over the passing years.
    End-stage kidney disease is the only chronic disease whose treatment is paid for by the United States government. The reason is simple: Dialysis, or kidney transplants, are necessary if patients are to live. That clinics had become a  “multibillion-dollar industry” came as a shock, however. The thrusts of the Times story was how hard it is for the government to do something about an expense even if it is found to be “stark” waste, and that, if the payments to dialysis centers were continued as before, it would be the result of excessive lobbying by the profit-making industry rather than new medical information.
    The cut proposed in this case is in the $500 million annual cost of providing patients with an anti-anemia drug, one element of the overall $32.9 billion government expense for the dialysis program. The Medicare Division of the Department of Health and Human Services had found that the drug was being overused, and it recommended that Congress approve a cut of $29.52 from the $246 per visit reimbursement planned for next year. Officials are now re-examining that cut, with a decision expected before the end of the year.
    If I was surprised that private corporations had taken over a government health program, I was dismayed by the Times report that the chief executive of one of the larger companies, DaVita Healthcare Partners of Denver, earned $26.8 million last year (a 53-percent jump since 2011), and that Warren Buffett’s company, Berkshire Hathaway, had moved to buy a larger share of the company. If you are among those who bristle at reports of the multimillion-dollar salaries that the heads of large financial corporations command, you may join me in concern that someone in charge of health care, and vital health care at that, is the recipient of such largesse. DaVita and other corporations are reported to be spending millions on lobbying efforts to protect their profits. The Times said DaVita alone had generated more than 80,000 letters and signatures from patients pleading with their representatives to eliminate the cut.
    Less prominent in the story in The Times was word that the proposed cut would hurt clinics in rural areas or in poor sections of large cities hardest, given that dialysis providers in those areas are apt to be nonprofit organizations or those with narrow profit margins. The story quoted a C.E.O. of one nonprofit chain saying she was afraid that some of its clinics would have to close if the cut went through. “Part of me is afraid until patients start dying, no one is going to believe that we can’t make it on this amount of money,” she said.
    It seems unconscionable, but par for the course, that corporations would prey on patients’ fears in order to maintain profitability, but the money-saving proposal also seems to point to government’s failure to concern itself with the poor — or with studies showing a relationship between anemia and the race or ethnicity of dialysis patients. If the muscle exerted by dialysis corporations is successful in getting the payment reinstated, the irony may be that it will turn out not only to help their bottom lines but those patients who need the anti-anemia drug most.