Editor's note: This explains only a small portion of what is wrong with the U.S. dialysis industry.
Dialysis patients with private insurance automatically convert to the Medicare rate after 33 months, so there is no financial incentive to increase long-term survival. Over the last several decades, a large percentage of U.S. nephrologists greatly profited from the rise of
the duopoly of Fresenius and DaVita, selling their dialysis patients/facilities to these companies, which utilized junk-bond financing for these purchases. For most patients, this led to minimal, standardized care (cheapest possible dialysis) that focused on meeting biochemical marker targets, which some have alleged have been the source of widespread fraud. Dialysis patient employment and rehabilitation, which drove rapid technological innovations in the 1960s, were abandoned by nephrologists after the government began paying for dialysis in 1973.
As a result, U.S. dialysis care has lagged far behind all other fields of medicine in terms of advances in survival and technology. When asked, virtually all U.S. nephrologists state they would avoid the treatment regimens that the vast majority of their patients receive. More than any other medical specialty, U.S. dialysis care has tied its practice of medicine to the servicing of junk-bond debt.