Many Don't Get Preventive Care

The End Stage Renal Disease Program doesn't address prevention, a major focus of the health care debate.

Barry Straube, chief medical officer at the federal Centers for Medicare & Medcaid Services, says 25 million Americans have kidney disease, but Medicare benefits don't kick in until patients are at the most advanced stage. Many patients with earlier-stage kidney disease aren't treated for high blood pressure or diabetes, which cause two-thirds of kidney failures.

"It's kind of immoral the way it works now," says Bill Peckham, 45, a dialysis patient and blogger in Seattle. Though about one in five dialysis patients

die every year, Peckham says, "you keep the chairs filled with new people, because Medicare doesn't show up until you're in the dialysis unit."

J. Michael Lazarus, Fresenius' chief medical officer, says: "Every nephrologist would love to see patients earlier. But nobody sends them. ... I've seen them in the emergency room at the end." That's because many rarely have seen any kind of doctor, let alone a kidney specialist, he says. End-stage renal disease "is a disease of the indigent," he says. "They show up because nobody treated their hypertension, nobody treated their diabetes."