The End Stage Renal Disease Program

Abstract

What happens when the federal government is virtually the only payer for a medical service that is privately provided? The best example of this is Medicare's End Stage Renal Disease Program. For 20 years, the government has essentially frozen the level of payments to facilities and physicians providing dialysis treatment, sharply reducing the real value of their remuneration. The End Stage Renal Disease Program is the subject of this report, my fifth on the American medical system¹⁵.To provide medical care in a program so constrained, providers have lowered operating costs, boosted productivity, and aggressively sought new patients. . . .