Dialysis treatment in USA: High costs, high death ratesSo what's the problem? John Graham at Critical Condition explains:
. . . Only 8% of U.S. dialysis patients treat themselves at home. The vast majority of the more than 350,000 Americans on dialysis are treated in centers, where three treatments a week, three or four hours each, is the norm -- not because it's optimal but because that's the way it has been done for nearly four decades.
A growing body of evidence suggests that longer and/or more frequent dialysis treatments, either at home or in a dialysis center, are far superior to the status quo. Although the USA spends more per dialysis patient than other countries, that does not result in higher survival rates or even, many argue, a better quality of life.
"The standard of care is really inappropriate," says Brenda Kurnik, [a] doctor, who practices in Marlton, N.J. "Basically, it prevents people from dying, and that's about all it does." . . .
[Foreign doctors] -- and many of their U.S. colleagues -- attribute the higher U.S. death rate in part to Medicare's own payment system and the resulting "one-size-fits-all" treatment.
The standard of care has become the three treatments a week for which Medicare pays, usually in a dialysis center, and no longer than four hours each. Home dialysis, which allows for longer, more frequent treatments, is more common in most countries with better survival rates.
The punch line? The U.S. government's Medicare program is the monopoly health insurer for patients who need the treatment. That goes a long way to explain why the protocol is frozen in time. Can you think of any medical specialty -- cardiology, psychiatry, orthopedic surgery, etc. -- where you can describe what's happening today as no different than four decades ago?Remind me, once again, why progressives prefer a "public option" when Medicare remains a mess? And getting worse?