The Price of Life

Some 10,000 Americans suffer irreversible kidney failure each year. The human body cannot survive longer than about three weeks unless it can rid itself of the waste products that are normally extracted by the kidneys and excreted in the urine. This means that the victims face certain death unless they can do one of two things: 1) receive intermittent dialysis treatments, in which the blood is removed from the body and cleansed of most of its impurities, or 2) get a kidney transplant. Both alternatives are expensive. Dialysis can cost $25,000 or more a year; a kidney transplant costs $15,000 to $25,000. Unless they are rich, qualify for veterans' benefits, or live in states that help pay for such care, many kidney patients simply cannot afford the price of life.

This economic obstacle, however, is about to be lowered. In its closing days, Congress amended the Social Security Act to provide federal support under Medicare for much of the cost of treating patients with end-stage kidney disease. The amendment, Section 2991 of the act, means that for the first time, the Government will accept responsibility for a group of patients regardless of age, occupation or financial status.

The new provision, which takes effect July 1, is comprehensive. It provides that if a kidney-failure victim has been paying Social Security taxes and has been on dialysis for three months, Medicare will pick up most of the hospital costs for continuing dialysis or a kidney transplant. If the individual subscribes to Part B of Medicare for $5.80 a month, the Government will pay 80% of his doctor bills.

Reaction to the law is enthusiastic. "This is a major breakthrough," says Dr. Ira Greifer, the National Kidney Foundation's medical director. Though firm figures are elusive, it was estimated that more than 8,000 people would die in 1972 for want of treatment that medical technology could supply. Presumably, this figure will drop substantially after the law takes effect.

What this will cost in tax dollars has yet to be determined. Dr. Theodore Steinman, director of dialysis at Boston's Beth Israel Hospital, expects the national total of patients receiving regular treatment to double to about 15,000, then level off. About half of those, it is estimated by the Department of Health, Education and Welfare, will qualify annually for Medicare aid (others will get help under other programs). Initial cost: $125 million.

With financing available, transplants, which are both more desirable and economical, should increase as the supply of donor kidneys permits. The Rogosin Kidney Disease Treatment Center at Manhattan's New York Hospital plans to double its transplants to 120 a year. The number of dialysis units, both in hospitals and in the privately owned "blood-washing service stations" that are springing up across the country, is also expected to increase.

Quality Control. So are the problems, unless strict standards are set by the Social Security Administration. Benjamin Burton, of the National Institute of Arthritis and Metabolic Diseases, believes that review boards should be established to evaluate the nature and quality of treatment provided kidney patients in hospitals and private facilities. He also feels that they should determine which patients are suitable candidates for either dialysis or transplants. (Dialysis was ruled out for former President Harry Truman, for example, because doctors felt it would not appreciably improve his condition.) Without such monitoring, abuses could jeopardize efforts to extend similar coverage to other diseases.

Such efforts seem likely to be undertaken. Louisiana's Senator Russell Long, one of the amendment's sponsors, tried in vain to get Congress to underwrite the cost of treating all catastrophic illness. But with kidney disease as a precedent, Congress may have a hard time withstanding the pressure of other medical lobbies who demand subsidized treatment of such illnesses as hemophilia, multiple sclerosis and heart disease.

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