In a previous life I was a hemodialysis nurse working in a dialysis clinic. Hemodialysis is a treatment given to patients with End stage Renal disease (ESRD); which is a fancy way of saying their kidneys have stopped working for whatever reason. Dialysis is the only way they will continue to live. If you take their access to hemodialysis away, they will die within 3 days to 2 weeks.
So the other day I heard two nephrologists (kidney doctors) talking over lunch about what they would do if Government sponsored single-payer healthcare were to be approved by Congress. Essentially their thoughts were that it would be an unmitigated disaster; and that thousands of people would die in San Antonio alone.
And that’s just the first year.
Let’s do the math. There are (roughly) 55 dialysis clinics in the Greater San Antonio area according to the Medicare Website (53 listed, plus unlisted federal clinics at Fort Sam Houston and Wilford Hall Medical facilities and the Audie Murphy Veterans Administration Hospital.) The clinics serve as few as 12 people or as many as 40 people per clinic. Each clinic dialyzes their people three times a day; so that’s two groups of patients (the Monday/Wednesday/Friday group and the Tuesday/Thursday/Saturday groups). Let’s say an average 20 people per clinic – times 3 shifts of people per day – times 2 groups – that’s roughly 6,720 patients.
And if I told you it was 10,000 patients, I’m sure it would still be a low estimate.
Diabetes (the number one reason for ESRD) is epidemic in the Hispanic population here; and Hypertension (high blood pressure – the number two reason for ESRD) is epidemic in the black and Hispanic populations.
Between Diabetes and Hypertension we’re talking about roughly 60% of all ESRD patients right there. As many as 30% of the balance are due to “chemical causes”, which usually means drug abuse. (see, there’s a reason they’re illegal. They’re extremely hard not only on your liver, but they’ll burn out your kidneys, too.
So that’s our patient base; Diabetics, Hypertensives, and Drug Abusers.
Dialysis is one of the largest outstanding costs of Medicare. Once you’re diagnosed with ESRD, your private insurance is prohibted by law from dropping you for six months until Medicare begins coverage. So it will be not only an obvious place, but the number one target for the bureaucratic bean-counters to cut Medicare costs.
So how long until someone decides that drug abusers don’t deserve dialysis? There’s an old joke that’s true among dialysis nurses that goes ‘Noncomopliant Diabetics and noncompliant Hypertensives become noncompliant ESRD patients. (“Noncompliant” means “they don’t do what the doctor tells them — they don’t take their medication; don’t amke their doctor’s appointments, miss their dialysis treatments, etc . . . ) How long until if your blood pressure isn’t controlled, you won’t get dialysis? How long until if your diabetes isn’t controlled, you won’t get dialysis?
The ultimate goal in dialysis, of course, is to qualify for a kidney transplant. That means you get on a waiting list, wait for years, and have to be extremely complaint with their medications, doctor’s appointments, lab tests, dialysis treatments, etc. It’s an extremely difficult regimen precisely because there are so few kidneys available for transplant — and the transplant organizations make it hard so they can be assured that people getting transplant kidneys will take goodcare of them.
How long until somebody decides that all ESRD patients should comply with transplant standards or lose their dialysis? Hey, they’re just drug abusers, right? They’re just people who are too lazy to make their doctor’s appointments, or take their medicines, right?
How long until any of us that miss a doctor’s appointment lose their choices in healthcare?
And who makes those decisions?
Some doctors are already making contingency plans for that future — and a lot of them are planning on getting out of medicine.
Something to think about.