The Policy Proposition: saving America’s only universal healthcare program

by Alexander Chang (’23) | April 8, 2022

Art by Marisea Fisher (’24)

President Richard Nixon signed the End-Stage Renal Disease (ESRD) program into law on July 1, 1973 to cover some ten thousand patients who lacked access to proper dialysis treatment. Fifty years later, more than five hundred thousand Americans out of an estimated thirty-seven million Americans currently suffering from chronic kidney disease are enrolled in the program. 

The exponential growth of dialysis care in the United States has begun to dampen its quality. Indeed, the universal coverage of renal disease ESRD offers private healthcare corporations a multitude of options to extract taxpayer dollars at an incredible scale. 

One of the largest healthcare providers that the federal government outsources renal care to is DaVita Dialysis. In 2021, the company reported close to two billion dollars in earnings, sixty-eight percent of which came directly from Medicare and other government health insurance programs. 

DaVita and other private healthcare providers such as Fresenius Medical Care, have taken advantage of broad federal regulations to maximize profits, often at the expense of the patient. Under federal law, dialysis centers are not required to have a doctor present in clinics and only require one nurse to be present in dialysis facilities—a loophole that DaVita, among other corporations, have taken advantage of to reduce operating costs. Indeed, private dialysis centers have a nurse-to-patient ratio thirty-five-percent lower than their nonprofit counterparts.

The intentional shortage of staff in DaVita centers has proven dangerous. High patient processing quotas combined with a lack of medical professionals in have resulted in staff members cutting corners in order to maintain patient inflows.

DaVita reports that these cuts supposedly make up for low medicare reimbursement rates, but their actions appear to say otherwise. In fact, they settled with the US Justice Department for 389 million dollars in 2014 after being charged with paying medical professionals kickbacks for patient referrals, even if it was against a patient’s best interest. In another 495 million dollar lawsuit, DaVita was found guilty of exploiting Medicare reimbursements by throwing away spare medication in order to charge federal programs for their replacements. 

These settlements overshadow individual centers’ issues. In 2017, two Chicago women died after staff in dialysis centers failed to provide proper care. Heather Cruthfield, one of the victims, had difficulty breathing, yet DaVita staff refused to call 911 and insisted on her taking a private ambulance to the University of Chicago hospital. Jackson Park Hospital was significantly closer but had no medical directors tied to DaVita.

That is not to say that DaVita and other companies are not serving the community. In fact, it’s very much the opposite. These companies are contributing greatly towards providing this service to Americans who need it, but we need to make sure that these services are safe, high quality, and available to all. Upholding these industries is key to strengthening the services that the ESRD promised. If we continue to scale back oversight and provide opportunities to exploit reimbursement programs, it will tarnish the care that so many Americans desperately need. 

Categories: Column, Opinions

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