The Cost of Dialysis circa 1973



When Eric Crystal came to dinner, his diet was a treatment as much as a meal.  Tonight it was pasta topped by the delicious green basil sauce that S.Q. Lapius had recently added to his culinary treasure trove.  “His kidney problem.  Have to keep his proteins low.”



Eric looked awful.  His skin was moist and wan.  He was deeply distressed.  “I hadn’t wanted to advertise the fact that I have been on kidney dialysis for over a year now.”



“I’m sorry you hadn’t told me, Eric.  I’ve gone out of my way to prepare special diets for you.  On dialysis you should be able to eat ‘most anything.  I’d have given you my special beef en brochette in the light chive sauce.”  He peered carefully at Crystal.  “I would think you are overdue for your dialysis, Eric.  You might even be slightly uremic right now.”  He leaned towards Eric and sniffed.  “You are, my friend.  What’s wrong?”



“That’s what I wanted to talk to you about, Simon.”



“Surely you don’t need my advice.  Isn’t Pier taking care of you?  One of the best men in the city.”



“I’m not seeking medical advice, Simon.  The fact is, I need money.”



”You’ve suffered financial reverses?”



“I guess you could call it that.  The fact is that I can’t afford to run the dialysis unit anymore, and I’ve been borrowing from friends.”



“Well, surely Eric, I can lend you some money,” said Simon, “how much do you need?”



“Frankly, Simon, if you can lend me $1,000 it will carry me for about 8 weeks.  I’m about a week overdue now.  And, of course, you are correct.  I am uremic.  And, of course, I’ll accept the thousand dollars, as a gift.  I have no way of paying you back.  On the other hand, if you don’t give it to me, I’ll be dead in a month.”



“Well, Eric, I must say you present a strong argument in favor of the loan or gift or whatever it is.  But there will come a point when your death will be on somebody’s conscience, I guess.”



“I’ll take the money and run, Simon, thanks.  But that’s not entirely why I came to you.  I use my dialysis unit three times weekly.  That leaves about 150 hours on my machine that could be devoted to helping someone else.  I was wondering, if all the dialysis units in the city were to be donated to a center, and if the city or state would staff the center, the existing machines in the city could service about 200 people instead of 20.”



“That’s been tried, Eric,” Lapius said softly.  “The answer that the state health department gives is that if they institutionalize and subsidize dialysis, they will have to buy more machines at about $15,000 each and the final cost to them will be, considering that they would then be committed to offer the service to everyone with renal failure, at least ten, and probably thirty million dollars a year.  When it’s done privately, the wealthy buy their machines, and the poor have to go through a process of selection to go on machines at public institutions.  And no one likes to serve on the selection committee, because for each reprieve, someone is condemned to die.  But you know, don’t you, that there is an amendment in the Congress to include kidney dialysis under the Medicare law?” 



“Yes, but that will be fiscal 1974, and I’ve got to stay alive until then.”



“Don’t worry, Eric.  We’ll find enough money for that.  But do you realize that it will cost the federal government $135 million the first year, and the estimates are that it will go to one billion in a decade?”



Lapius wrote a check and Eric, who had hardly touched his meal, thanked him warmly.  He even managed a smile as he left.



“A dreadful problem, Harry.” Lapius said later.  “Just imagine.  There are people in this country on the verge of starvation.  How will they feel if one of them qualifies for the dialysis program, and the government spends $7500 a year on their kidneys but can give them nothing for food?”



And a little while later, “Every American is eligible for coverage under Section 299 I, even those under 65 years of age.  You know, Harry, most people can live for years on food alone.”



“What’s that?” I asked looking up from my magazine.



“I simply said you can live for years on food alone.  It seems to me that adequate diet should be the first item of business under an extended Medicare law.  Food is a medicine.  Babies who grow up on an inadequate protein intake suffer mental retardation.”



“If they guarantee adequate diet under Medicare, they might not have enough money to support the dialysis coverage.”



“That’s true, but wouldn’t it be an irony if someone died because they were too weak from malnutrition to crawl to the dialysis center?”



“You wouldn’t want Eric to hear you say things like that.”



”No,” Lapius sighed, “I wouldn’t.”