...

A 1962 exposé in Life, “They decide who lives and who dies” shocked the nation and led to broad discussions about the ethics of rationing care. Dialysis patients became fierce advocates for their care, with one even undergoing dialysis in a congressional committee room. Congress could not ignore this public debate and in 1972, the treatment of end-stage kidney failure, including the use of dialysis, became the first illness to be covered by federal funds.

One of the main reasons that politicians and the general public supported this plan to fund the treatment of kidney failure and particularly the very high costs of dialysis was that those suffering from kidney failure at the time were disproportionately young, white, employed and seen to have fallen sick through no fault of their own. This approach highlighted America’s view of health as an individual responsibility and the imperative for productivity. Those who had protected their health and still fell ill warranted a carveout.

Federal funding for the treatment of kidney disease was a welcome relief for many patients, families and health-care providers. But it also created new health policy problems. As the number of dialysis patients rapidly rose, their demographics changed, the population of sick people became older and sicker, and for-profit chains emerged to capitalize on the assured government funding for treating this condition. While policymakers solved the original rationing problem, they created new ones and ignored countless other flaws in the system.

...