America does more dialysis than any other country IIRC. Very few other places do dialysis on 80 year olds. This is a values decision… and it’s for the worse imo ftmp.
That’s not untrue, but that’s a bit different. Lots of docs don’t take Medicaid because there are tons of higher reimbursing patients that they could take care of instead.
But in this case, ESRD is kind of single payer. So it’s not like if you refuse Medicare, you can still have a bunch of other higher paying patients ESRD patients This ruling seems to reduce those other higher paying patients dramatically.
Wasn’t there some kind of thing where big dialysis was actively discouraging or lobbying to prevent treatments that would get people off of dialysis? Seems like a 60 minutes or similar piece maybe 10-15 years ago…
Here is an article from a quick google. Bottom line is that the incentives don’t line up well with either cost control or patient care (but great for the two companies profits).
If you have end stage renal disease, you’re pretty much not getting off dialysis unless you get a transplant. Or you die.
I didn’t read Dan’s link, but can you give some cliffs on how a dialysis company can help someone get a transplant?
I’d have just assumed that’s the nephrologist’s job. I can see issues if the nephrologist has an ownership stake in the dialysis center, but how often is that the case with people who get their dialysis at DaVita?
The link has more to do with getting people to switch to private insurance which pays up like 17x and also the for profits have a much higher complication risk, they end up buying the device makers and other things.
Now that the transplant list has been brought up, I believe the old thing I saw was about that. That they would keep on the dialysis and discourage transplants.
I’d love to hear the sales pitch on that. How do you sell people on voluntarily choosing to drag their ass down to the dialysis center for three half-days a week for the privilege of probably dying sooner?
I assume they would be lying their asses off, but presumably anyone with ESRD has a nephrologist, who could help them make a non-idiotic decision.
I’m almost 3 months into a new job at one of the two “Big Dialysis” providers.
Obviously I don’t make market setting decisions about how much to get reimbursed, or anti competitive practices between Davita and Fresenius,
So I’m just gonna say that we have way more candidates for chairs than chairs available, it’s limited terribly by staffing, and just about all our patients are two weeks away from death without the treatments we provide.
I (somewhat proudly) don’t understand the economics and incentives that makes this all work, because I know what I cost. But I take some satisfaction in giving these people the dignity and quality of life that wouldn’t have existed even just a few decades ago.
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Well, let us know if/when they try to get you to discourage transplants.
We actually have good bye parties celebrating when people get transplants. Us encouraging or discouraging that has very little to do with if people can actually get one
We have a 14 year old kid with Alport’s Syndrome. He’s the only one I know is even on a transplant list that has a realistic shot of getting one.
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If I understood Dan correctly, it sounded like people would get a match on the list and the dialysis center would encourage them to turn it down and just keep coming in for dialysis. I’m having a real hard time believing that worked on anyone.
John Oliver segment probably.
Two years ago:
I can’t find what I saw many years ago in particular but it was definitively along these lines.
Surf captured it best. Today’s status is in response to complaints of the past. It is still accurate today that outcomes are not as good in the for profits. Basically it’s business-ification of medicine as opposed to medicine for medicines sake.
My ex is a veterinary technician and she had a friend that was a dental tech. Some of the profit motive shenanigans in each field was shocking to hear.
My dad is on a transplant list (he was on two, but one removed him) and yeah, he knows he’s probably only getting a kidney from a living donor. He hasn’t gotten to dialysis yet - his numbers actually improved last year, hopefully extending his “no dialysis” window.
He even jumped through a million hoops to work with some orthodox Jewish group in NYC that matches patients with living donors. He had to fly out there and visit their approved doctors, do tests, etc. Required a really long application, essays, and even a letter of recommendation from a rabbi or community leader. What’s nuts is that if somehow it works out (it won’t), he’d have to stay in NYC for months or some shit after the surgery. I told him that if it came to that, once he’s recovered make some excuse to fly back home and then just stay there. What are they going to do, take his kidney away?
We’re hoping my brother can donate a kidney. My dad wouldn’t let either of us do it, but my brother forced his hand by saying he was going to donate a kidney to SOMEONE, even if it’s not him. He’s done a bunch of tests, but hasn’t found out yet if it’s a go.
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Also UC-San Francisco is working on an artificial kidney. They’ve had a successful test of a prototype, but are still a long ways off from a finished product. Haven’t started human testing yet. I donated some money a while back. Hopefully this will pan out some day.
I have a good friend whose husband had a transplant that was failing after a few years.
It turns out his best friend was a stellar match. It’s been a minute but last I heard it was going very well with kidney #2. Much better than the first one.
It never ceases to amaze me as to how we’re always on the verge of living in a scientific utopia and also a modern hellscape.
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That’s why there are so many sci-fi stories with an elite and technical society living the good life “above” off the labor of the poors and backwards “lower” society. (Elysium, the time machine…)