By Kevin F. Erickson, Melandrea Worsley and Wolfgang C. Winkelmayer
Fifty years ago, on October 30, then-President Richard Nixon signed the Social Security Amendments of 1972, which created the End-Stage Renal Disease (ESRD) program. In extending Medicare benefits to people with kidney failure regardless of their age, this landmark legislation availed universal health care coverage for most persons with kidney failure.
Technological innovations in the treatment of kidney failure combined with a political movement to expand the role of government in health care begot the 1972 legislation. In the 1950s kidney transplant had emerged as a treatment option. By the early 1960s, innovations in dialysis machines and vascular access made it possible to treat chronic uremia with dialysis. These technological breakthroughs transformed kidney failure from a terminal illness into a treatable chronic condition. Although the first long-term dialysis center opened in 1962, most patients with kidney failure could not afford dialysis.
As new dialysis and transplant therapies emerged, enactment of the Medicare entitlement program in 1965 generated momentum toward building a national health system. In this context, the need to ration limited dialysis resources conflicted with commonly held moral sentiments. A 1962 LIFE magazine feature titled “They Decide Who Lives, Who Dies” helped to frame the dilemma through the vivid depiction of a “God committee” tasked with rationing limited dialysis care. The controversial selection processes included consideration of demographics, geography, past and projected occupational performance, and an assessment of moral character. Every congressional body between 1965 and 1972 introduced a bill to expand the government’s role in the financing of treatments for catastrophic kidney disease.
Read the full journal article at JAMA.
