Don’t “Shake Up” my Kidney Care.

Sometimes life gets busy and your blog falls by the wayside; lots of things you want to do but no time to do it. See also: Me from the beginning of May until now.

And then sometimes you read an article that you need to respond to and it’s just too damn long for a Facebook post. See also: Me, reading this piece from Politico on the Trump Administration’s plans to “Shake Up” Kidney Care.

The gist of the story is that the Trump Administration wants to overhaul the “Kidney Care” system, namely Dialysis, and get people out of clinics and in to home treatment options. This, in theory, allows more people to make it to the transplant process and saves the government a buttload of money in paying for these treatments.

Given this administration’s lack of movement and empathy on ensuring health coverage for vulnerable Americans as it stands right now, I am very suspicious about the true motives behind this proposal.

Listening to and reading this make me think this is less about “innovation in care” and getting people out of the stand-alone clinics (Watch John Oliver’s show about Dialysis… the system is pretty fucked), and more about finding ways to trim the Medicare budget. Medicare pays for 100% of Dialysis (Thanks Nixon!). That’s roughly $114 Billion a year.

I’m a huge proponent for home dialysis options. Home treatments, like Home Hemodialysis and Peritoneal Dialysis, are cheaper than in-clinic options due to not having to pay for staffing. However, home treatments are no walk in the park. Home Hemo requires you to have a trained caregiver to help monitor your vitals as your blood goes wooshing through a machine and to make sure you don’t have a sudden blood pressure drop and die. PD, which is what I did, involves tubes in your stomach and bags of medical waste every night. It might be a bit presumptive of me, but I equate it to chemotherapy. It is an intense medical treatment that you are having to administer yourself, or via someone you find to help you, regardless of how bad you are feeling.

Related Post: My Kidney Failure Story

It’s hard. I was 27 and had no other health issues working against me and it was hard. A majority of people who go on Dialysis are older and have other chronic health issues that they are juggling on top of being tethered to a machine that serves as a major organ for upwards of 10 hours a day (Mine was overnight).

I’m concerned that pushing the care out of clinics and on to the patient will make it easier to cut that from Medicare coverage. For reference, just one night on my dialysis was $6,000. Just the treatment; not the meds, not the sanitation supplies, not the weekly/monthly clinics… Just the treatment. I had to do it every night for 18 months, and those costs add up quick. I would not have been able to stay alive without Medicare covering those costs.

This strikes me as a way to trim the Medicare budget at the expense of people’s lives. Which is bullshit because if you want to “shake up the Kidney Care”, there is an entire industry of for profit Dialysis Centers that are profiting off of keeping people in a state of near death. Those could stand to have some scrutiny and regulation to provide both better care and a lower cost of service. Again, I really recommend you watch the John Oliver episode. They did a great job.

Innovation and empowering patients to take control of their own care is a vital aspect to long-term success with any chronic condition. However, I don’t believe that you can single out one condition to “shake-up” without looking at the big picture of our health care system. This administration has been ignoring the health care needs of our most vulnerable citizens and rolling back legislation that provided PREVENTIVE care that would prevent or delay people needing Kidney Care treatments.

My health, wellbeing, and life is not a budget line item. My kidneys do not need to be shaken. Health Care isn’t a bargaining chip in your giant game of Risk. Don’t undo one of the two good things that Richard Nixon managed to do.