In connection with the fact that my wife may soon be at the stage of kidney disease where a transplant or dialysis is recommended, we've recently been researching the cost of and advantages/disadvantages of dialysis vs. transplantation. It won't affect us, because my wife is already a Medicare beneficiary based on being over 65, rather than solely because having end-stage renal disease, but this research has revealed an utterly INSANE aspect of our current health care system that affects everybody who reaches end stage renal disease when they're younger.
First, on the merits of dialysis vs. transplantation. There is no question that for the great majority of people, transplanation and permanent treatment with anti-rejection drugs is vastly preferable to dialysis, both from the standpoint of the person's health, and the effects on their lifestyle. If you get a transplant from somebody with whom you're reasonably compatible immunologically, it's a matter of taking several pills per day -- very expensive pills, but pills. You can hold a regular job, take normal vacations, and otherwise live a normal life. If you're on dialysis, on the other hand, you spend major parts of 3 days per week connected to a dialysis machine. And while there are potential side effects to anti-rejection drugs, they tend to be much less serious than those of dialysis.
What's more, transplantation is vastly cheaper than dialysis. I'm sure these figures have gone up, since they're from a 2009 article, but there is no indication that the relative comparison has changed.
As of 2009, a transplant cost approximately $109,000, and anti-rejection drugs cost $17,000 per year. By contrast, dialysis cost 173,507 per year. So even in the year of the transplant, it's cheaper than dialysis, and in the succeeding years, it is vastly cheaper.
Medicare benefits pay for dialysis, and also for transplantation and the anti-rejection drugs. But here is the truly INSANE thing: While Medicare will pay for dialysis for as long as the patient lives, it will only pay for anti-rejection drugs for 3 years. When the Medicare benefit for end-stage renal disease was first enacted, anti-rejection drugs were only covered for one year, because there was hope that after an initial period, the patient would permanently accept the new organ. The one year period was extended to three years, but the companies that comprise the dialysis industry (including those such as Amgen that provide drugs that dialysis patients must take) have lobbied vigorously in opposition to annual bills sponsored by Dick Durbin and others to provide permanent coverage for anti-rejection drugs, and to pay for it by taking funding from dialysis -- even though if more people could have transplants and avoid rejecting them, there would be much less need for the more expensive dialysis.
The Ventura County Star ran an excellent four-part series of articles on kidney transplantation that you can read here.
You can read Senator Durbin's bill, S. 1454, here. The companion bill in the House, H.R. 2969, sponsored by Republican Representative (and physician) Michael Burgess can be seen here. One would think that with a Democratic lead sponsor in the Senate and a Republican lead sponsor in the House, and with having the benefit of both saving money and improving the quality of patients' lives, this would be passed easily. But instead, it has been bottled up in relevant House and Senate committees without hearings .
The only explanation I can fathom is that we have the best government that money can buy, and if it puts money into the pockets of the right corporations, and from them into the campaign coffers of the right politicians, the welfare of the public (both kidney patients and taxpayers) be damned.