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.”