Dialysis may seem like an unusual topic for the political Last Week Tonight and John Oliver, but it’s incredibly important. Here’s why.
So, how much have you thought about dialysis? Not at all? Well, you’re certainly not alone, but be assured that this is a serious health issue that should occupy at least a few of your brain cells.
Even John Oliver knows that this sounds a little strange. After all, Last Week Tonight is better known for its political bent, with recent episodes that zeroed in on Jared Kushner and Ivanka Trump, the French political election, and net neutrality. But, as Oliver says, “I promise you, this is worth listening to”.
Dialysis is a treatment for people suffering from advanced kidney disease. Essentially, as Oliver explained, “a machine acts as your kidneys by taking blood out of your body, cleaning it, and then returning it to you. Think of it as a Brita pitcher for your blood”. Gross, to be sure, but an effective analogy.
This history of dialysis treatment is pretty rough. Early years of treatment meant that dialysis machines were in limited supply. One hospital even had, in Oliver’s word, a “death panel” that determined which patients were able to access lifesaving treatment.
In Who Gets to Live?, a 1965 NBC film on the subject, its writers seriously did not pull punches. When a narrator asks a doctor what happened to patients who couldn’t get treatment, he simply says: “they’re dead”. Even John Oliver seemed genuinely taken aback.
In 1972, Richard Nixon — yes, that Richard Nixon — signed a bill stating that the government would pay for all dialysis treatment. It was an extraordinary move that greatly helped the 10,000 or so dialysis patients at the time. However, the United States now has nearly 500,000 dialysis patients seeking treatment. The system, as Oliver explained, is clearly overloaded and ripe for corruption.
The reality of dialysis
As important as dialysis may be, however, it’s an exhausting process. Patients who receive treatment at dialysis center are hooked up to machines for 3-4 hours at a time. Even then, their health care outcomes are, frankly, pretty grim.
Later in the segment, Oliver explained that, after one year of dialysis, the average death rate of patients hits 25%. After five years of treatment, a patient’s mortality rate skyrockets to about 65% percent. Ultimately, this means that kidney transplants can double or even triple survival rates.
Yet, dialysis centers like the for-profit ones run by Davita do little to emphasize how important kidney transplants are to patients. When a Last Week Tonight staffer visited a pre-dialysis “Kidney Smart” class, one Davita educator even claimed that patients turned down prospective kidney transplants. It’s a choice,” she said. “You don’t have to do a transplant. I’ve patients that decided, ‘No, I don’t want that.’”
Apparently, these patients were so fond of the “community” of the dialysis center — where, need we remind you, they were hooked up to medical equipment for hours at a time, with a seriously grim health outlook — that they turned down a lifesaving kidney transplant.
Ridiculous as that may sound, you to delve even deeper into the for-profit dialysis business to get a sense of just what’s happening. Oliver couldn’t help but spend a few minutes illustrating the bizarre behavior of Davita CEO, Kent Thiry.
Kent Thiry and his Three Musketeers cosplay
How odd? First of all, Thiry loves the 1998 Leonardo DiCaprio film, The Man in the Iron Mask, so much that he dresses up like a musketeer for numerous meetings and conference appearances. In fact, the film was so important to him that it pushed Thiry to make a “transformative life decision” that led to his acceptance of his present CEO position.
Also, he calls his company a “village”, its employees “citizens”, and consistently refers to himself as the “mayor” of Davita.
But all of this would be in the realm of gentle oddness if not for the way he runs Davita. Thiry, a former banking consultant, basically manages Davita like a business. At a 2009 UCLA talk, he said that “For me, it’s not about the patients, it’s about the teammates.” Plus, he’s made at least one unfortunate comparison with fast food, saying that he would run his centers just like he would a series of Taco Bell restaurants. Just let that sink in for a bit.
This is all great for those with a financial stake in Davita, but less so for its patients. Some people undergoing dialysis at Davita centers claim that they feel more like products being moved along a line, rather than people in need of serious medical care.
The experience of medical staffers points in the same direction. One even said that, given a 15 to 25 minute turnover time between patients, they were unable to properly sanitize equipment. This is despite already loose federal guidelines, which say that centers don’t need a doctor on site, and only requires a single nurse to be present in a given center.
Accusations against Davita and other for-profit dialysis companies
All of these issues have led to a series of accusations and lawsuits leveled against the company. Some claim that Davita offered kickbacks to doctors who referred patients to their dialysis clinics. Others claim Medicare fraud, wherein doctors used only partial amounts of medicine from a vial, then discarded it. The more discarded vials, you see, the more money the government contributes to the company.
Davita has settled practically all of these claims out of court. All told, the company has spent almost a billion dollars in recent years, solely on settlements. Davita claims that it’s only taking these steps to avoid litigation and a potential loss of federal funding. Still, it looks mighty suspicious.
It’s worth noting here that Davita is only one of a number of for-profit dialysis companies. Other centers have much the same problems, though they can’t boast a CEO who may have gone a little too far with his The Man in the Iron Mask fanfiction.
Here’s what you can do
If all of this seems overwhelming, there’s actually a few things you, the individual citizen, can do.
The especially generous and brave amongst us can sign up to be live organ donors. After all, you have two kidneys. One of them could be removed and used to save the life of a person suffering from late stage kidney disease. If you’re one of those truly noble souls, then check out http://giveandlive.us/ for more information.
At the very least, you can sign up to become an organ donor after your own passing. Making these wishes clear is especially important. Signing up for the program is as checking a box on a form the next time you’re at the DMV.
If you’re not already an organ donor, become one as soon as possible. You could make a huge difference in someone’s life. Plus, then you get to use the show’s latest hashtag – #whenidiepleasetakemykidneys.