By John Buntin -- Dialysis Death Panels and the Health-Care Debate

By John Buntin
Sunday, August 23, 2009

Death panels: Republicans warn they'recoming; Democrats say such a thing is unimaginable.

Something about the health-care debate gets people arguing about improbable scenarios, such as the United States turning into Canada or the government killing grandmas. But in the case of death panels, the overheated rhetoric has some historical truth. For a decade, there actually were death panels in this country. And it was big government that ended them.

Before World War II, there was no cure for chronic kidney disease. If your kidneys stopped cleansing your blood of toxins, you died. But in the late 1930s and early '40s, a Dutch physician, Willem Kolff, hit upon an ingenious solution: pumping the blood of patients suffering from end-stage renal failure through a machine that eliminated waste. Using 50 feet of sausage casing wrapped around a wooden drum that rotated in a tank of water and salts, Kolff invented the first dialysis machine.

Kolff's device wasn't perfect (in part, perhaps, because at the time he was also busy organizing Europe's first blood bank, participating in the Dutch resistance to the Nazis and hiding a Jewish boy in his home). The first 16 people he hooked up to his machine died anyway. But in 1945, Kolff finally got his "artificial kidney" working correctly. After the war, he moved to the United States, where he and other scientists quickly made significant improvements to the machine. By the early 1960s, researchers in Seattle had perfected a Teflon shunt that allowed patients with chronic kidney disease to be on dialysis indefinitely, dramatically extending their lives.

But there was a problem: money. At the time, dialysis for one patient cost more than $10,000 a year. The University of Washington Hospital, which had put up the money to support the first dialysis patients, saw an impending crisis as more and more people lined up for treatment, and administrators decided not to admit anyone else until additional funding was secured.

In 1962, with help from a $100,000 foundation grant, Seattle's King County Medical Society opened an artificial kidney clinic at Swedish Hospital and established two committees that, together, would decide who received treatment. The first was a panel of kidney specialists that examined potential patients. Anyone older than 45 was excluded; so were teenagers and children; people with hypertension, vascular complications or diabetes; and those who were judged to be emotionally unprepared for the demanding regimen. Patients who passed this first vetting moved on to another panel, which decided their fate. It soon gained a nickname -- the "God committee."

Born of an effort to be fair, the anonymous committee included a pastor, a lawyer, a union leader, a homemaker, two doctors and a businessman and based its selection on applicants' "social worth." Of the first 17 patients it saw, 10 were selected for dialysis. The remaining seven died.

In the fall of 1962, Life magazine published a story about the "life and death committee." In Washington, D.C., the deputy surgeon general fired off a memo to the secretary of health, education and welfare, warning that "strong pressure for some federal action" from the public might ensue.

It didn't. Instead, as the technology spread, medical centers in other cities struggled to serve large numbers of patients with limited numbers of dialysis machines. The rise of home dialysis reduced the number of people excluded from treatment, but panels across the country still met to decide who would receive access to the life-saving treatment. Supply was one limitation. Money was another, and the ability to pay often meant the difference between life and death.

Finally, in 1972, Congress decided to step in and provide federal funding for dialysis through the recently created Medicare program. The availability of treatment exploded. Today nearly half a million Americans suffer from end-stage renal disease, and dialysis is helping keep 340,000 alive.

So what does this tell us about what universal heath insurance might mean? It tells us that, if history is any guide, the government will expand access to health care, not curtail it. Federal involvement has never led to death panels. It has only ended them.

John Buntin writes about health and crime for Governing magazine and is the author of the forthcoming book "L.A. Noir: The Struggle for the Soul of America's Most Seductive City."

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