In America, there is exactly one universal health program that has somehow escaped the rhetorical alarums about “socialised medicine”. Anyone who needs dialysis for kidney failure can get it, free at the point of use. The service may be provided by big corporations reimbursed by the US government, and the clinics usually in dingy strip-malls between burger joints and nail salons – but this is a good thing overall, isn’t it?
It could be, as Tom Mueller’s grimly fascinating and humane exposé shows, were it not for the sector’s rampant corruption, weird CEOs – staff at one corporation are encouraged to dress up as musketeers – and staggering disdain for patients. Dialysis is ruled by a duopoly of publicly traded companies, Fresenius and DaVita, who operate on the model dubbed “fast-food medicine”. (Not coincidentally, the giant US hospital chain, Hospital Corporation of America, was co-founded by the man who had previously overseen the national expansion of Kentucky Fried Chicken.)
We learn in How to Make a Killing that this means cutting costs to the bone – by, for example, hiring less-qualified and lower-paid “dialysis technicians” rather than nurses – and maximising revenues by dialysing each patient as rapidly as possible, even if slower sessions would be better for their health. (This is known, not admiringly, as “bazooka dialysis”.) Company representatives hover around patients’ bedsides and railroad into a profitable dialysis slot people who don’t even require it.
Muller has learned this from talking to hundreds of patients, doctors, and whistleblowing workers: one of the latter tells him that they often don’t even have enough time to wipe the blood off the dialysis couch between patients. And woe betide anyone who complains about the substandard care they receive in such a clinic: staff may invent histories of abusive behaviour in order to subject the patient to “involuntary discharge”, which means refusing to continue treating them and banning them from the facility. This can mean death, but there is no inalienable right to be treated by a private clinic.
How did such a system evolve? In an unplanned way, much like our own organs: “In the early weeks of development,” Mueller explains in his limpid summary of nephrological science, “amphibian, reptile, bird and mammalian embryos all grow… two throwback kidneys that first appeared in our marine ancestors, the jawless and the bony fishes.”
