A new proposal from Medicare has been published in the Federal Registry and it provides a window on how medical care will be delivered in the future under a government-run system. Medicare is proposing to provide a fixed budget for the medical care of dialysis patients and the details of the plan guarantee that patients will have a private company intervening in physician decisions whether to provide expensive but highly beneficial drug therapies.

The end stage kidney disease program, better known as kidney dialysis, is the one aspect of Medicare that applies to persons less than 65 years old. This quirk in the system began in the 1960s in order to help fund the expensive dialysis programs that were feasible but enormously costly on a per treatment basis. These are life-saving treatments and could not possibly be affordable to most patients. Over the years, the program has grown larger and larger because more and more patients were found to benefit from the treatment. The cost per treatment is actually about 64% of the costs 20 years ago, factored for inflation, as tremendous efficiencies have been introduced. But the program has grown to now cost 6.4% of Medicare’s total budget or some $23 billion in 2006. This is because over 350,000 patients receive dialysis treatments in the United States.